{"id": "1e1491100126-0", "page_content": "\u201cSocial anxiety and shyness can become so intense that they prevent people from en -\njoying life. This book is ideal for anyone who wants to learn to be more comfortable \naround other people. Drs. Antony and Swinson have taken proven treatments for social \nanxiety and adapted them for a non-professional audience. The step-by-step strategies \ndescribed in this book have been shown to be effective, are easy to understand, and \nare sure to help the reader cope better in social situations. Anyone who experiences \nsigni\ufb01cant anxiety when performing or when interacting with other people should read \nthis book!\u201d\n\u2014 Aaron T. Beck, MD, university professor of psychiatry at the \nUniversity of Pennsylvania\n\u201cIf you have trouble with social anxiety, you will \ufb01nd the book by Drs. Antony and \nSwinson to be an excellent resource. This highly experienced duo has provided an excel -\nlent road map to guide you through your efforts to overcome your anxiety and improve \nthe quality of your life. Based on the tried and true methods of cognitive-behavioral \ntherapy and on the results of many scienti\ufb01c studies, the techniques described in this \nbook will help you feel better when you are with other people or the center of atten -\ntion. The only thing you have to do is work hard and apply them. Best wishes for your \njourney along that road.\u201d\n\u2014 Richard Heimberg, Ph.D., director of the Adult Anxiety Clinic  \nof Temple University, Philadelphia\n\u201cDrs. Antony and Swinson provide practical advice in a highly readable format. This \nbook will be invaluable to people whose social anxiety prevents them from leading full \nand happy lives.\u201d\n\u2014 Murray B. Stein, MD, professor of psychiatry and director of \nanxiety and traumatic stress disorders program at the University", "source": "shyness_social.pdf"}
{"id": "1e1491100126-1", "page_content": "anxiety and traumatic stress disorders program at the University  \nof California, San Diego", "source": "shyness_social.pdf"}
{"id": "7e3977fe64c0-0", "page_content": "\u201cThis is an excellent resource written by world-renowned and skilled clinicians and  \nresearchers in the area of anxiety disorders. Drs. Antony and Swinson present the most \nup-to-date information about social anxiety and its treatment in a way that is clear and, \nmost importantly, that provides step-by-step tools for overcoming this disorder. This is \na must-read for persons suffering with social anxiety.\u201d\n\u2014 Michelle G. Craske, Ph.D., professor of psychology at the \nUniversity of California, Los Angeles\n\u201cThis workbook by Antony and Swinson gives the millions of people whose lives are \nlimited by social fears the hope to control their future. The book is clear, practical, easy \nto follow, and, above all, based on solid, scienti\ufb01c ground. The sections on troubleshoot -\ning are especially valuable to really help \ufb01ne-tune the techniques. I would strongly rec -\nommend this book to anyone who is serious about overcoming their social fears.\u201d\n\u2014 Ronald M. Rapee, Ph.D., professor of psychology at Macquarie \nUniversity, Sydney, Australia, author of Overcoming Shyness and  \nSocial Phobia\n\u201cThis volume, written by a team composed of a psychologist and a psychiatrist, is an \noutstanding workbook for any individual suffering from social anxiety or shyness and \nwishing to undertake a structured self-help program to overcome it. The book can be \nused alone or in conjunction with therapy. The authors are experts in their \ufb01eld and they \noffer strategies that are solidly grounded in the latest research literature. The workbook \nformat provides readers with the exercises and worksheets they need to do the dif\ufb01cult \nwork required to overcome their shyness and social anxiety.\u201d\n\u2014 Jacqueline B. Persons, Ph.D., director of the San Francisco Bay", "source": "shyness_social.pdf"}
{"id": "7e3977fe64c0-1", "page_content": "\u2014 Jacqueline B. Persons, Ph.D., director of the San Francisco Bay \nArea Center for Cognitive Therapy and clinical professor in the \ndepartment of psychology at the University of California, Berkeley", "source": "shyness_social.pdf"}
{"id": "ada8c9337b94-0", "page_content": "MARTIN M. ANTONY , PH.D.\nRICHARD P . SWINSON, MD\nNew Harbinger Publications, Inc.PROVEN, STEP-BY-STEP TECHNIQUES \nFOR OVERCOMING YOUR FEARTheShyness & Social Anxiety Workbook\nSECOND EDITION", "source": "shyness_social.pdf"}
{"id": "a5db73e053bf-0", "page_content": "Publisher\u2019s Note\nCare has been taken to con\ufb01rm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and \npublisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express \nor implied, with respect to the contents of the publication.\nThe authors, editors, and publisher have exerted every effort to ensure that any drug selection and dosage set forth in this text are in accordance \nwith current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the \nconstant \ufb02ow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in \nindications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently \nemployed drug.\nSome drugs and medical devices presented in this publication may have Food and Drug Administration (FDA) clearance for limited use in restricted \nresearch settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical \npractice.\nDistributed in Canada by Raincoast Books\nCopyright \u00a9 2008 by  Martin M. Antony and Richard P . Swinson  \nNew Harbinger Publications, Inc.  \n5674 Shattuck Avenue  \nOakland, CA 94609  \nwww.newharbinger.com\nCover design by Amy Shoup\nT ext design by Michele Waters\nAcquired by Catharine Sutker\nEdited by Carole Honeychurch\nAll Rights Reserved\n               \nLibrary of Congress Cataloging-in-Publication Data\nAntony, Martin M.", "source": "shyness_social.pdf"}
{"id": "a5db73e053bf-1", "page_content": "Library of Congress Cataloging-in-Publication Data\nAntony, Martin M.\n  The shyness and social anxiety workbook : proven, step-by-step techniques for overcoming your fear / Martin M. Antony \nand Richard P . Swinson. -- 2nd ed.\n       p. cm.\n  Rev. ed. of: The shyness & social anxiety workbook.\n  Includes bibliographical references (p.         ).\n  ISBN-13: 978-1-57224-553-2 (pbk. : alk. paper)\n  ISBN-10: 1-57224-553-0 (pbk. : alk. paper)  1.  Bashfulness--Problems, exercises, etc. 2.  Social phobia--Problems, \nexercises, etc.  I. Swinson, Richard P . II. Antony, Martin M. Shyness & social anxiety workbook. III. Title. \n  BF575.B3A58 2008\n  158.2--dc22\n                                                            2008016264", "source": "shyness_social.pdf"}
{"id": "08395352697b-0", "page_content": "For our students.\n\u2014MMA and RPS", "source": "shyness_social.pdf"}
{"id": "b52c096e8d23-0", "page_content": "Contents\nAcknowledgments  vii\nIntroduction  1\nPart 1  Understanding Your Social Anxiety\nChapter 1   Shyness and Social Anxiety  5\nChapter 2   Why Do You Have These Fears?  29\nChapter 3   Getting to Know Your Social Anxiety  39\nPart 2  How to Overcome Social Anxiety and Enjoy Your Life\nChapter 4   Making a Plan for Change  65\nChapter 5   Medications for Social Anxiety and Social Anxiety Disorder  93\nChapter 6   Changing Your Anxious Thoughts and Expectations  107\nChapter 7   Confronting Your Fears Through Exposure  143\nChapter 8   Exposure to Social Situations  165\nChapter 9   Exposure to Uncomfortable Sensations  191\nChapter 10  Communicating More Effectively  203\nChapter 11   Maintaining Your Improvements and Planning for the Future  233", "source": "shyness_social.pdf"}
{"id": "10685a3c9a76-0", "page_content": "The Shyness & Social Anxiety Workbook\nviRecommended Readings  239\nNational and International Associations Providing Referrals  245\nInternet Resources  249\nReferences  251", "source": "shyness_social.pdf"}
{"id": "3c743c5d506a-0", "page_content": "Acknowledgments\nThere are many people without whom this workbook would not have been possible. \nFirst, we wish to acknowledge those who were instrumental in developing and investi -\ngating the treatments described in this book. Dr. Aaron T. Beck pioneered many of the \ncognitive strategies that are used throughout the world to treat anxiety, depression, and \nmany other conditions. We are also indebted to Drs. Isaac Marks, S. Rachman, Joseph \nWolpe, David Barlow, and others who helped to develop and study the exposure-based \nstrategies that are now commonplace for the treatment of anxiety. We also acknowledge \nthe important contributions of Drs. Richard Heimberg, Samuel Turner, Deborah Beidel, \nDavid M. Clark, and others who adapted these cognitive and behavioral methods for the \ntreatment of social anxiety.\nA special thank-you goes out to our colleagues, clients, and patients who provided \nmany helpful suggestions over the years that informed this second edition of The Shyness \nand Social Anxiety Workbook . Finally, we wish to express our gratitude to the staff at New \nHarbinger Publications (including Carole Honeychurch, Matthew McKay, Catharine \nSutker, Amy Shoup, Dorothy Smyk, and many others), who worked closely with us \nthrough all stages of developing, editing, and marketing this book.\n\u2014 Martin M. Antony, Ph.D.  \nRichard P. Swinson, M.D.  \nToronto, Canada", "source": "shyness_social.pdf"}
{"id": "19c63baaf81e-0", "page_content": "Introduction\nShyness and social anxiety are universal. From time to time, almost everyone has felt \nnervous speaking in front of a group or anxious when interacting with another person. \nWe wonder if a presentation has gone well or whether we have made a good impression \non a \ufb01rst date or a job interview. In fact, even some celebrities, who make their living \nin the public eye, have been described as excessively shy from time to time, including \nHarrison Ford (actor), Mary Chapin Carpenter (singer), Michelle Pfeiffer (actor), David \nBowie (rock star), David Letterman (talk-show host), Nicole Kidman (actor), and Carrie \nUnderwood ( American Idol  winner). There have also been reports in the media about \nmusical performers like Barbra Streisand, Carly Simon, and Donny Osmond suffering \nfrom performance anxiety. Even radio \u201cshock jock\u201d Howard Stern has described himself \nas being painfully shy when he is outside the safe con\ufb01nes of his on-air studio. (FYI, \ndetails on other shy celebrities can be found at www.shakeyourshyness.com/shypeople  \n.htm.)\nShyness and social anxiety can range in intensity from being fairly mild to completely \nincapacitating. In extreme cases, social anxiety may prevent an individual from develop -\ning friendships, working, or even standing in a public place. Regardless of whether your \nfears are minor or completely overwhelming, the strategies described in this book will \nhelp you to deal more effectively with social anxiety.\nWe recommend that you read this workbook in the order in which the chapters \nappear. The initial chapters are designed to educate you about the nature of social \nanxiety and to teach you how to evaluate the main features of your own social anxiety.", "source": "shyness_social.pdf"}
{"id": "19c63baaf81e-1", "page_content": "anxiety and to teach you how to evaluate the main features of your own social anxiety. \nThen we discuss the costs and bene\ufb01ts of different treatment approaches and help you to \nselect among available treatment options. Subsequent chapters provide detailed informa -\ntion about particular treatment strategies including medications, cognitive therapy for \nchanging your anxious thoughts, using exposure to confront the situations you fear, and", "source": "shyness_social.pdf"}
{"id": "75f4a819d4cb-0", "page_content": "The Shyness & Social Anxiety Workbook\n2\ufb01ne-tuning your communication and performance skills. The \ufb01nal chapter of the book \ndiscusses strategies for maintaining your improvements.\nThis book is different from other self-help books in a number of ways. Of the many \nbooks on social anxiety and shyness that you will \ufb01nd in your local bookstore, this was \nthe \ufb01rst to be written in a workbook format. It is \ufb01lled with exercises and practices \ndesigned to teach you basic strategies for overcoming shyness and social anxiety. We \nencourage you to \ufb01ll in the blank worksheets and forms located throughout the text. In \naddition, we encourage you to make copies of the forms for your personal use so you \ncan continue to use them over the coming months.\nThis book also differs from many others because the strategies we recommend have \nall been investigated extensively in well-designed clinical studies. In addition to specializ -\ning in helping people deal more effectively with their anxiety, we also are actively involved \nin research on the nature and treatment of anxiety. It is a well-established fact that when \nthe techniques described in this book are used in a therapeutic setting, people generally \nexperience a signi\ufb01cant decrease in their social and performance anxiety (Rodebaugh, \nHolaway, and Heimberg 2004). Essentially, we have taken strategies that have proven \nto be useful in therapy and adapted them into a self-help format. Recently, investigators \nhave also shown that our self-help approach (using the \ufb01rst edition of this book) can \nalso be effective for reducing social anxiety (Moore, Braddock, and Abramowitz 2007). \nThis workbook is designed so that it can be used alone or coupled with regular visits to", "source": "shyness_social.pdf"}
{"id": "75f4a819d4cb-1", "page_content": "This workbook is designed so that it can be used alone or coupled with regular visits to \na professional therapist. In fact, a motive for writing this book was to have a good refer -\nence our own clients and patients can use as they progress through therapy.\nThis second edition has been thoroughly updated with the latest scienti\ufb01c knowl -\nedge and references concerning the nature and treatment of social anxiety (for example, \nthe section on the genetic underpinnings of social anxiety now includes a discussion \nof the Human Genome Project, which hadn\u2019t been completed when the \ufb01rst edition \nwas  published). The chapter on medications has also been revised to include the latest \ninformation on medications that have only recently been studied for treatment of social \nanxiety. Sections that were previously unclear or out of date have been completely \n rewritten. We have added many new examples and several forms and diaries have been \nupdated and simpli\ufb01ed. New sections have been added as well, including a discussion \nof strategies for improving motivation for treatment and sections for family members \nand friends of people who suffer from social anxiety. Finally, the lists of recommended \n readings and Internet resources have been thoroughly updated.\nThe journey to overcoming your shyness and social anxiety may not be an easy one. \nSome aspects of your fear will be easier and quicker to overcome than others. Also, \nfor every two or three steps forward, you may experience what feels like a step back. \nNevertheless, the techniques described in this book have been shown to reduce social \nand performance fears in most people who use them consistently. With hard work and \nperseverance, these strategies will provide you with the opportunity to make big, posi -\ntive changes in your life.", "source": "shyness_social.pdf"}
{"id": "e1da16cd3b7f-0", "page_content": "PART 1\nUnderstanding Your  \nSocial Anxiety", "source": "shyness_social.pdf"}
{"id": "d5249b4bb142-0", "page_content": "CHAPTER 1\nShyness and Social Anxiety\nRachel was a twenty-six-year-old woman who worked as an assistant manager of a small \nbookstore. She was referred to our Anxiety Treatment and Research Centre to get help \nfor intense anxiety about her upcoming wedding. Rachel wasn\u2019t afraid of being married; \nin fact, she looked forward to spending years together with her husband. She was terri -\n\ufb01ed of the wedding itself. The idea of being on display in front of such a large audience \nwas almost unthinkable. In fact, she had postponed her wedding twice before because \nof her fear of being the center of attention.\nRachel\u2019s anxiety involved more than just a fear of her wedding. She reported that \nshe\u2019d always been shy, even when she was very young. When she was in high school, \nher anxiety around people had become so intense that it was affecting her school life. \nShe was convinced that her classmates would \ufb01nd her dull or boring, or that they would \nnotice her anxiety and assume that she was incompetent. Typically, Rachel avoided doing \noral reports at school and didn\u2019t take any classes where she felt her performance might be \nobserved or judged by her classmates (such as physical education). On a few occasions, \nshe even asked for special permission to hand in a written essay instead of doing a pre -\nsentation in front of the class. Despite being an excellent student, she generally tended \nto be very quiet in class and rarely asked questions or participated in class discussions.\nThroughout college, Rachel found it dif\ufb01cult to make new friends. Although people \nenjoyed her company and often invited her to parties and other social events, she rarely \naccepted the invitations. She had a long list of excuses to get out of socializing with", "source": "shyness_social.pdf"}
{"id": "d5249b4bb142-1", "page_content": "accepted the invitations. She had a long list of excuses to get out of socializing with \nother people. She was comfortable only with her family and a few longtime friends, but \naside from those, she usually avoided contact with other people.\nAfter college, Rachel began working at a bookstore, and after a short time, she \nwas promoted to assistant manager. She was always comfortable dealing with custom -\ners at her store, and she gradually became more comfortable talking to her coworkers.", "source": "shyness_social.pdf"}
{"id": "e3959aec583a-0", "page_content": "The Shyness & Social Anxiety Workbook\n6However, she avoided eating lunch with other staff members, and she never attended \nany social events, including the company\u2019s annual holiday party.\nRachel lived with her social anxiety for years, despite how it interfered with her \neducation, work, and social life. It was not until the anxiety prevented her from having \nthe kind of wedding she and her \ufb01anc\u00e9 wanted that she decided to seek help.\nRachel\u2019s story is not that different from those of other people who experience \nintense feelings of shyness, social anxiety, and performance-related fears. The types of \nanxious beliefs and behaviors that she reported are similar to those that many socially \nanxious people describe. After her evaluation at our center, Rachel began a twelve-\nsession course of cognitive behavioral therapy (CBT) and gradually learned to cope with \nher anxiety more effectively. By the end of treatment, her avoidance of social situations \nhad decreased signi\ufb01cantly, and Rachel was much more comfortable in situations that \npreviously made her very anxious.\nCBT involves (1) identifying the thought patterns and behaviors that contribute to \npeople\u2019s negative feelings, such as anxiety, and (2) teaching people new ways of thinking \nand behaving to better manage their anxiety. This book will teach you the strategies \ncommonly used in CBT for social anxiety. Before exploring those strategies, however, we \nwill begin this chapter in the same way we usually begin treatment with the individuals \nwe see in our program\u2014with an overview of the nature of fear and anxiety in general, \nand of social anxiety in particular.\nANXIETY, WORRY, FEAR, AND PANIC\nEveryone knows what it feels like to be afraid. Fear is a basic human emotion. In humans,", "source": "shyness_social.pdf"}
{"id": "e3959aec583a-1", "page_content": "fear is controlled, in part, by an area of the brain called the limbic system. The limbic system \nincludes some of the deepest, most primitive structures of the brain\u2014structures shared \nby many less \u201cevolved\u201d animals. In fact, there is reason to believe that the emotion of fear \nis present across most, if not all, animal species. Most organisms display speci\ufb01c patterns \nof behavior when confronted with danger and often these \u201cfearful\u201d behaviors include \nforms of aggression or escape. Therefore, the intense feelings we experience when we are \nexposed to an immediate danger often are called the \u201c\ufb01ght-or-\ufb02ight\u201d response.\nAlthough most people use the terms \u201canxiety\u201d and \u201cfear\u201d interchangeably, behav -\nioral scientists who study emotions assign somewhat different meanings to these and \nother related terms (Barlow 2002; Su\u00e1rez et al., in press). Anxiety is a future-oriented \nfeeling of dread or apprehension associated with the sense that events are both uncon -\ntrollable and unpredictable. In other words, anxiety is a nagging feeling that occurs when \na person believes a negative event may occur in the future and that nothing can be done \nto prevent it.\nPeople who feel anxious tend to dwell upon and ruminate about the possibility of \ndanger. This tendency to dwell on future negative events is called worry. Anxiety is also \nassociated with uncomfortable physical feelings such as arousal (for example, sweatiness, \nincreased pulse), tension (for instance, tight muscles), and pain (like headaches).", "source": "shyness_social.pdf"}
{"id": "ac9f62b7144b-0", "page_content": "Shyness and Social Anxiety\n7There is no question that when anxiety is too intense it can interfere with perfor -\nmance; however, mild to moderate amounts of anxiety are actually helpful. If you never \nbecame even slightly anxious under any circumstances, you probably wouldn\u2019t bother \ndoing the things that must be done. Why would you bother preparing an assignment on \ntime, dressing nicely for a date, or eating healthy food if you weren\u2019t concerned about \nthe consequences of not doing these things? In part, it is anxiety that motivates us to \nwork hard, prepare for challenges, and protect ourselves from possible threats.\nIn contrast to anxiety, fear is a basic emotion that occurs when an individual is con -\nfronted with an immediate real or imagined danger. Fear leads to a sudden, intense \nphysiological alarm reaction that essentially has one purpose\u2014to get the person away \nfrom the danger as quickly as possible. When people feel fearful, their bodies go into \noverdrive to ensure that escape is fast and successful. Heart rate and blood pressure \nincrease to transfer blood to the large muscles. Breathing quickens to improve the \ufb02ow \nof oxygen throughout the body. People sweat to cool off the body and perform more \nef\ufb01ciently. In fact, all of these symptoms of arousal and fear are designed to make escape \neasier, allowing for survival in the face of danger.\nPanic attack  is the clinical term used to describe the experience of intense fear that \ntakes place even though no realistic danger is actually present. Panic attacks can be trig -\ngered by speci\ufb01c situations that people fear (for example, giving an oral presentation, \nbeing in a high place, seeing a snake) or they sometimes occur out of the blue, without", "source": "shyness_social.pdf"}
{"id": "ac9f62b7144b-1", "page_content": "any obvious trigger. Panic attacks are discussed in more detail later in this chapter.\nTo summarize, fear is an emotional reaction to an immediate danger, whereas anxiety \nis a state of apprehension about some future threat. For example, worrying about giving \na presentation that is a week away is a re\ufb02ection of anxiety, whereas experiencing an \nadrenaline rush while in the midst of giving a presentation is usually an example of \nfear.\nHere are a few points to remember: \n1. Anxiety and fear are normal emotions everyone experiences from time to \ntime.\n2. Anxiety and fear are time-limited. Even though they feel as though they \nmay continue forever, they always decrease over time.\n3. Anxiety and fear have a helpful function in that they prepare you for future \nthreats and protect you from danger. So, your goal should not be to rid \nyourself of all fear and anxiety. Rather, your goal should be to reduce your \nanxiety to a level that no longer interferes signi\ufb01cantly with your life.\nWHAT IS A SOCIAL SITUATION?\nA social situation is any situation in which you and other people are present. Social situ -\nations can include those that involve interacting with others (these are often referred to", "source": "shyness_social.pdf"}
{"id": "b4196a3bab12-0", "page_content": "The Shyness & Social Anxiety Workbook\n8as interpersonal situations ) or situations in which you are the focus of attention or might be \nnoticed by others (these are often called performance situations ). Examples of interpersonal \nsituations and performance situations that may be feared by people with high levels of \nsocial anxiety include:\nInterpersonal Situations\nU\u00caAsking someone out on a date\nU\u00caTalking to someone in authority\nU\u00caInitiating or maintaining a conversation\nU\u00caGoing to a party\nU\u00caHaving friends over for dinner\nU\u00caMeeting new people\nU\u00caTalking on the telephone\nU\u00caExpressing a personal opinion\nU\u00caHaving a job interview\nU\u00caBeing assertive (for example, saying no when you don\u2019t want to do \nsomething)\nU\u00caReturning an item to a store \nU\u00caSending back food in a restaurant\nU\u00caMaking eye contact\nPerformance Situations\nU\u00caPublic speaking\nU\u00caSpeaking in meetings\nU\u00caPlaying sports or participating in aerobics\nU\u00caPerforming a piano recital in front of others\nU\u00caHaving others watch you work\nU\u00caLeaving a recorded message on somebody\u2019s voice mail\nU\u00caGetting married", "source": "shyness_social.pdf"}
{"id": "28bf1cc7af76-0", "page_content": "Shyness and Social Anxiety\n9U\u00caActing on a stage\nU\u00caReading out loud in front of others\nU\u00caEating or drinking in front of others\nU\u00caUsing public bathrooms with others in the room\nU\u00caWriting with others watching (for example, completing a form in public)\nU\u00caMaking a mistake in public (for example, falling down, dropping your keys, \nand so on)\nU\u00caWalking or jogging on a busy street or some other public place\nU\u00caIntroducing yourself to a group of people\nU\u00caShopping in a busy store\nWHAT IS SOCIAL ANXIETY?\nSocial anxiety refers to nervousness or discomfort in social situations, usually because of \nfear about doing something embarrassing or foolish, making a bad impression, or being \njudged critically by others. For many people, social anxiety is limited to certain types \nof social situations. For example, some people are very uncomfortable in formal work-\nrelated situations, like presentations and meetings, but are quite comfortable in more \ncasual situations, like parties and socializing with friends. Others may show the exact \nopposite pattern, with formal work situations being easier than unstructured social gath -\nerings. In fact, it\u2019s not unusual to hear of a celebrity who is quite comfortable performing \nin front of large audiences but who otherwise feels shy and nervous when interacting \nwith people one-on-one or in small groups.\nThe intensity of social anxiety and the range of feared social situations vary from \nperson to person. For example, some people experience fear that is fairly manageable, \nwhereas others are completely overwhelmed by the intensity of their fear. For some people, \nthe fear is limited to a single social situation (for example, using public restrooms, public", "source": "shyness_social.pdf"}
{"id": "28bf1cc7af76-1", "page_content": "speaking), whereas for others, the social anxiety occurs in almost all social situations.\nThe experience of social anxiety is related to a number of common personality \nstyles and traits including shyness , introversion , and perfectionism . People who are shy often \nfeel uncomfortable in certain social situations, particularly when they involve interact -\ning with others or meeting new people. People who are introverted tend to be quieter \nand more withdrawn in social situations and may prefer being alone, compared with \npeople who are extroverted or outgoing. However, introverted people are not neces -\nsarily anxious or fearful when socializing. Finally, the trait of perfectionism is associated \nwith a tendency to hold overly high standards for oneself that are dif\ufb01cult or impossible \nto meet. Perfectionism can lead people to feel anxious in public for fear that other people", "source": "shyness_social.pdf"}
{"id": "fcf0df9ad1c0-0", "page_content": "The Shyness & Social Anxiety Workbook\n10will notice their \u201c\ufb02aws\u201d and judge them negatively. Perfectionism is discussed again later \nin this chapter.\nHOW COMMON IS SOCIAL ANXIETY?\nIt is dif\ufb01cult to obtain accurate estimates of the prevalence of social anxiety because \ndifferent studies have tended to de\ufb01ne social anxiety differently and used different ques -\ntions when interviewing people about their anxiety. Nevertheless, researchers have con -\nsistently found that shyness and social anxiety are common experiences. For example, in \na survey of more than 1,000 people from across the United States and elsewhere, psy -\nchologist Phillip Zimbardo and his colleagues (Carducci and Zimbardo 1995; Henderson \nand Zimbardo 1999; Zimbardo, Pilkonis, and Norwood 1975) found that 40 percent of \nthose who were asked currently considered themselves to be chronically shy, to the point \nof it being a problem. Another 40 percent reported that they had previously considered \nthemselves to be shy. Fifteen percent more considered themselves to be shy in some \nsituations and only 5 percent reported that they were never shy. More recent surveys \nsuggest that the prevalence of shyness may be even higher (for a review of studies on \nthe prevalence of shyness, see Henderson and Zimbardo 1999).\nResearchers have also studied the prevalence of social anxiety disorder (a condition \nassociated with extreme social anxiety that will be described later in this chapter). In \na recently published survey of more than 9,000 Americans (Kessler et al. 2005), about \n12 percent of people reported having the necessary symptoms to receive a diagnosis of", "source": "shyness_social.pdf"}
{"id": "fcf0df9ad1c0-1", "page_content": "12 percent of people reported having the necessary symptoms to receive a diagnosis of \nsocial anxiety disorder at some point in their lives. In fact, social anxiety disorder was \nfound to be the fourth most prevalent psychological problem in this study, after depres -\nsion, alcohol abuse, and speci\ufb01c phobias (for example, phobias of animals, blood, needles, \nheights, \ufb02ying, and so on). Other researchers have found the prevalence of social anxiety \ndisorder to be lower than 12 percent, but almost all studies have con\ufb01rmed that social \nanxiety disorder is a common problem (Kessler et al., in press).\nDifferences Between Men and Women\nShyness and social anxiety are common across both sexes, although most studies \nhave found that social anxiety disorder is slightly more prevalent in women than in men \n(Somers et al. 2006). There are a number of possible explanations for why women are \nmore likely than men to report fearing social situations. First, it\u2019s possible that men are \nactually more anxious in social situations than they are willing to admit. For example, \nthere is evidence from studies of other phobias that men underestimate their levels of \nfear (Pierce and Kirkpatrick 1992). Also, in Western societies, women are often expected \nto be more socially active than men. Therefore, men may be able to avoid certain types \nof social situations more easily than women, without being harassed about their absence \nand without experiencing as much social pressure from others in their day-to-day lives.", "source": "shyness_social.pdf"}
{"id": "b5b26d45f5be-0", "page_content": "Shyness and Social Anxiety\n11There also may be differences in the types of social situations that men and women \nfear. One study found that men with social anxiety disorder were more fearful than \nwomen of urinating in public bathrooms and returning items to stores, whereas women \nwith social anxiety disorder were more fearful than men of situations such as talking to \npeople in authority, public speaking, being the center of attention, expressing disagree -\nment, and throwing a party (Turk et al. 1998).\nCultural Differences\nIt is challenging to measure social anxiety across cultures because signs of social \nanxiety in one culture may have a very different meaning in another culture. For example, \nwhereas some cultures may view poor eye contact as a sign of shyness or social anxiety, \nother cultures often avert their eyes from contact with another as an appropriate sign \nof respect. Cultures also differ with respect to their use of pauses and silence during \nconversation, the preferred physical distance from others, and the appropriate tone of \nvoice (Sue 1990).\nDespite the dif\ufb01culties in measuring social anxiety across cultures, studies gener -\nally suggest that social anxiety and shyness are common across different ethnic groups. \nHowever, it should be noted that in the United States and Canada, the majority of \npeople who seek treatment for social anxiety disorder tend to be white and have a \nEuropean background. Although people from nonwhite, non-European backgrounds are \njust as likely to experience problems with social anxiety, they are less likely to seek help \nfrom a mental health professional.\nHOW DOES SOCIAL ANXIETY AFFECT  \nPEOPLE\u2019S LIVES?\nIn this section, we will discuss how a person\u2019s social anxiety can affect relationships,", "source": "shyness_social.pdf"}
{"id": "b5b26d45f5be-1", "page_content": "In this section, we will discuss how a person\u2019s social anxiety can affect relationships, \nwork and school, and other day-to-day activities. After reading each section, take a few \nmoments to consider how your social anxiety affects each of these areas of your life, and \nthen describe this in the space provided.\nRelationships\nSocial anxiety can make it dif\ufb01cult for people to establish and maintain healthy rela -\ntionships. It can affect all levels of relationships, from those with strangers and casual \nacquaintances to those with family and signi\ufb01cant others. For many people, even the \nmost basic forms of social interaction (such as making small talk, asking other people \nfor directions, saying hello to a neighbor) are very dif\ufb01cult. For such a person, dating", "source": "shyness_social.pdf"}
{"id": "c330020c55b8-0", "page_content": "The Shyness & Social Anxiety Workbook\n12may be completely out of the question. Social anxiety may be more manageable around \nmore familiar people, such as close friends and family\u2014but not always. For some people, \nanxiety may actually increase as a relationship becomes more intimate. Also, social anxiety \ncan interfere with existing relationships, particularly if a socially anxious person\u2019s partner \nwants to socialize with others on a more regular basis. The following case examples illus -\ntrate how social anxiety can have a negative impact on a person\u2019s relationships.\nU\u00caWilliam has never been in a romantic relationship. Although others have \nexpressed interest in dating him, he always makes excuses not to go out and \nusually doesn\u2019t return their phone calls. William desperately wants to be in a \nrelationship, but he just can\u2019t \ufb01nd the courage to take the initial steps.\nU\u00caCindy is generally comfortable with her male colleagues at work, and she \nhas several male friends with whom she socializes occasionally. However, as \nher relationships with men become closer, she is increasingly fearful that the \nother person will discover the \u201creal\u201d Cindy and reject her. She has ended \nseveral relationships with men just as they were becoming close.\nU\u00caJerry frequently argues with his girlfriend about his unwillingness to spend \ntime with her friends. Although he was quite shy and anxious when they \n\ufb01rst started dating, recently his social anxiety has put more of a strain on \ntheir relationship. Because of his anxiety, they have been spending a lot of \ntime alone while she has wanted to socialize as a couple with other people.\nU\u00caNorm has gradually lost many of his friends over the years. For a while after \n\ufb01nishing high school, he kept in touch with his closest friends. However,", "source": "shyness_social.pdf"}
{"id": "c330020c55b8-1", "page_content": "\ufb01nishing high school, he kept in touch with his closest friends. However, \nbecause of his anxiety, he often dreaded returning their calls and almost \nnever accepted their invitations to get together. Eventually, his friends \nstopped calling him.\nU\u00caAlison\u2019s roommate consistently plays loud music after midnight, making it \nimpossible for her to sleep. Despite feeling very frustrated and angry, Alison \navoids asking her roommate to turn down her music for fear that her words \nwon\u2019t come out right or that her roommate will think she is an idiot.\nU\u00caWhen talking to people whom she doesn\u2019t know well, Julia tends to speak very \nquietly, keep her distance, and avoid eye contact. As a result, people at work \nhave started to leave her alone and they rarely invite her to lunch anymore.\nIn the space below, record the ways in which social anxiety has affected your friendships \nand relationships.", "source": "shyness_social.pdf"}
{"id": "06980e21692d-0", "page_content": "Shyness and Social Anxiety\n13Education and Career\nSigni\ufb01cant social anxiety can have an impact on a person\u2019s education and career. \nIt can affect the types of courses you take in school and the types of jobs you might \naccept. It can also affect job performance as well as your enjoyment of school or work. \nConsider the following case examples:\nU\u00caNaveen turned down a promotion at work that involved signi\ufb01cant super -\nvisory responsibilities, including chairing a weekly staff meeting and train -\ning groups of staff. Although the promotion would have provided him with \na signi\ufb01cant increase in salary, Naveen was terri\ufb01ed of speaking in front \nof groups, and he couldn\u2019t even imagine being able to lead the weekly \nmeetings.\nU\u00caRuth dropped out of college partway through her third year. As a fresh -\nman and sophomore, Ruth had been able to be anonymous in her large \nclasses. However, when her classes became smaller in her junior year, she \nfelt increased pressure to participate in class. She began avoiding her lec -\ntures and eventually left school.\nU\u00caLen dreads going into work each day. He is terri\ufb01ed to speak to his cowork -\ners and avoids speaking to his boss at all costs. Although he never misses \nwork, Len keeps the time he must talk to others at a minimum. He rarely \ntakes a break for fear that others will ask him to have lunch or to spend their \nbreaks with him.\nU\u00caCheryl has been out of work for two years. Although she often hears of jobs \nthat might be interesting, the thought of having to go through a formal inter -\nview is completely overwhelming. On several occasions she has arranged for", "source": "shyness_social.pdf"}
{"id": "06980e21692d-1", "page_content": "view is completely overwhelming. On several occasions she has arranged for \njob interviews and then failed to show up because of her social anxiety.\nU\u00caPeople at work think that Jason is a snob. He tends to be very serious, and \nhe speaks very little to others. Even when someone asks him a question, he \ntends to answer with only one or two words. In reality, he isn\u2019t a snob; he is \njust very shy and anxious around people at work.\nIn the space below, record the ways in which social anxiety has affected your work or \neducation.", "source": "shyness_social.pdf"}
{"id": "7cd305b75006-0", "page_content": "The Shyness & Social Anxiety Workbook\n14Other Day-to-Day Activities\nJust about any activity that involves contact with other people can be affected by \nsocial anxiety. The following examples illustrate the range of situations and activities that \nare often dif\ufb01cult for people who are socially anxious.\nU\u00caSita avoids going shopping on Saturdays because the stores are so crowded \nand she is fearful of having other people watch her. In fact, just walking \ndown a busy street is sometimes dif\ufb01cult for her.\nU\u00caMichael screens all of his phone calls. He is very anxious when speaking to \npeople on the phone because he \ufb01nds it is more dif\ufb01cult to know how they \nare reacting to what he says as compared to speaking in person.\nU\u00caKalinda has stopped going to the gym. She was \ufb01nding that exercising in \nfront of other people was causing her too much anxiety. Instead she exer -\ncises at home, where no one can see her.\nU\u00caReid noticed a small hole in a sweater that he had just purchased. Although \nhe had not worn the sweater and it still had all the original tags, he was \nunable to return the sweater for fear of looking foolish in front of the \nsalesperson.\nIn the space below, record the ways in which social anxiety has affected your day-to-day \nfunctioning.\nSOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)\nWhen social anxiety becomes particularly severe, it may develop into a condition known \nas social anxiety disorder. Social anxiety disorder (also called social phobia ) is one of several \nanxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,", "source": "shyness_social.pdf"}
{"id": "7cd305b75006-1", "page_content": "anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, \nText Revision  (DSM-IV-TR; American Psychiatric Association 2000). The DSM-IV-TR is \nthe guide used by mental health practitioners to identify and diagnose various types of \npsychological problems. DSM-IV-TR diagnoses don\u2019t tell us much about the causes  of \nthe disorder. Instead, the disorders listed in the DSM-IV-TR are simply descriptions of \nbehaviors and experiences that cause interference or distress in a person\u2019s life. In short, \nthey are a way of classifying emotional and psychological problems.", "source": "shyness_social.pdf"}
{"id": "34e4bab31fdc-0", "page_content": "Shyness and Social Anxiety\n15Although there is strong evidence that some of the DSM-IV-TR disorders (for \nexample, schizophrenia, Alzheimer\u2019s disease) are associated with a biological dysfunc -\ntion, the evidence is much less clear for other disorders. The problems listed in the \nDSM-IV-TR range from severe mental illnesses to disorders that most people would \nconsider \u201cbad habits.\u201d In fact, the DSM-IV-TR even includes such problems as nicotine \ndependence and impaired sleep resulting from jet lag or shift work.\nIf your anxiety symptoms meet the diagnostic criteria for social anxiety disorder, \nthat does not mean that you are sick, have a disease, or are mentally ill. What it does \nmean is that you are experiencing social anxiety at a level that bothers you or interferes \nwith aspects of your functioning. Remember that almost everyone experiences social \nanxiety, shyness, or performance anxiety from time to time. The social anxiety experi -\nenced by people with social anxiety disorder is associated with the same types of anxious \nthoughts and behaviors that most people experience. The difference is that people with \nsocial anxiety disorder experience social anxiety at a more intense level, more frequently, \nand often in a wider range of situations than people without social anxiety disorder. \nFortunately, social anxiety disorder responds extremely well to the types of treatment \ndiscussed throughout this book.\nDiagnostic Criteria for Social Anxiety Disorder\nA diagnosis of social anxiety disorder requires that a person have an intense and \npersistent fear of one or more social or performance situations. Typically, the fear is \nrelated to anxiety over being scrutinized by others or doing something embarrassing or \nhumiliating. In addition, the fear must bother the individual or cause signi\ufb01cant interfer -\nence in his or her life. In other words, a person would not receive a diagnosis of social", "source": "shyness_social.pdf"}
{"id": "34e4bab31fdc-1", "page_content": "anxiety disorder if he or she had a strong fear of public speaking but didn\u2019t need to speak \nin front of groups and didn\u2019t care about having the fear. On the other hand, a person \nwho fears public speaking and needs to speak in front of groups (for example, a school -\nteacher) might be considered to have social anxiety disorder if the criteria are all met.\nSocial anxiety is often a feature of other problems. For example, people with eating \ndisorders may be nervous about having other people notice their unusual eating habits. \nPeople who wash their hands excessively due to obsessive-compulsive disorder (OCD) \nmay avoid people either for fear of being contaminated by others or for fear of having \nother people notice their OCD symptoms (such as frequent washing, red hands from \nwashing, and so on). In these examples, the social anxiety would be viewed as part of \nthe other problem, rather than as social anxiety disorder per se. For social anxiety dis -\norder to be diagnosed as a separate problem, there must also be extreme social anxiety \nthat is unrelated to any other problems that are present. For example, the person might \nhave a general fear of looking stupid, appearing boring to others, or making mistakes in \nfront of other people\u2014over and above the anxiety about having others notice his or her \ncompulsive washing or unusual eating habits.", "source": "shyness_social.pdf"}
{"id": "ee4a12bf8d0c-0", "page_content": "The Shyness & Social Anxiety Workbook\n16Diagnosing social anxiety disorder is a complicated task. The information outlined \nin this section gives you an idea of how mental health professionals distinguish different \ntypes of problems from social anxiety disorder. However, this overview will probably not \nbe enough for the purpose of self-diagnosis. If you want to be sure about whether your \nsymptoms meet the diagnostic criteria for social anxiety disorder, we recommend that \nyou see a psychiatrist or psychologist who has experience and expertise in the assess -\nment of anxiety disorders.\nUnfortunately, even professionals sometimes have dif\ufb01culty agreeing about whether \nthe diagnostic criteria for a particular disorder are met. For many people, the criteria \noutlined in the DSM-IV-TR don\u2019t \ufb01t as neatly as we might like, which makes diagnosis \nespecially challenging. Fortunately, the exact diagnosis isn\u2019t always necessary for select -\ning an effective treatment. The strategies described in this book will be useful for over -\ncoming shyness and performance anxiety regardless of whether the full criteria for social \nanxiety disorder are met.\nOne \ufb01nal note about the diagnosis of social anxiety disorder: if all of the criteria for \nsocial anxiety disorder are met and the person is fearful of almost all social situations, the \nperson is said to have generalized social anxiety disorder.\nTHREE COMPONENTS OF SOCIAL ANXIETY\nIn an effort to de\ufb01ne shyness, Cheek and Watson (1989) surveyed 180 shy individu -\nals about the types of experiences that are associated with shyness and social anxiety. \nEighty-four percent of the participants\u2019 responses to the survey fell into one of three \ncategories: the physical aspects of social anxiety (uncomfortable feelings and sensations), \nthe cognitive aspects of social anxiety (anxious thoughts, expectations, predictions), and", "source": "shyness_social.pdf"}
{"id": "ee4a12bf8d0c-1", "page_content": "the cognitive aspects of social anxiety (anxious thoughts, expectations, predictions), and \nthe behavioral aspects of social anxiety (for example, avoidance of social situations).\nCognitive behavioral treatments for social anxiety encourage people to think of \ntheir social anxiety in terms of these three components. In other words, when you feel \nanxious, you should pay attention to what you feel, think, and do. Breaking down your \nsocial anxiety into these components will help to make the problem feel less overwhelm -\ning and will set the stage for using the strategies outlined in this book.\nSocial Anxiety and Physical Feelings\nAnxiety in social situations is often associated with a long list of physical arousal \nsymptoms, and some of these feelings may themselves be sources of fear and anxiety. \nFor example, people with elevated social anxiety are often especially fearful of symp -\ntoms that may be noticeable to other people, such as shaky hands, sweating, blushing, \nand a trembling voice. Examples of feelings that you may experience in social situations \ninclude:", "source": "shyness_social.pdf"}
{"id": "8f8d65eca45f-0", "page_content": "Shyness and Social Anxiety\n17U\u00caRacing or pounding heart\nU\u00caBreathlessness or smothering feelings\nU\u00caDizziness or lightheadedness\nU\u00caDif\ufb01culty swallowing, choking feelings, or a \u201clump\u201d in the throat\nU\u00caQuivering or shakiness (for example, in the hands, knees, lips, or whole \nbody)\nU\u00caBlushing\nU\u00caNausea, diarrhea, or \u201cbutter\ufb02ies\u201d in the stomach\nU\u00caExcessive sweating\nU\u00caShaky voice\nU\u00caTearfulness, crying\nU\u00caPoor concentration or forgetting what you were trying to say\nU\u00caBlurred vision\nU\u00caNumbness and tingling sensations\nU\u00caFeelings of unreality or being detached\nU\u00caTightness or weakness in the muscles (for example, wobbly legs, sore neck)\nU\u00caChest pain or tightness in chest muscles\nU\u00caDry mouth\nU\u00caHot \ufb02ushes or chills\nPeople who are socially anxious differ from one another with respect to the ways in \nwhich they experience these feelings when they are anxious. Some people report many \ndifferent physical symptoms. Others report only a few of these feelings. In fact, some \npeople are not aware of any physical sensations when they are anxious.\nThere is also evidence that people are often unable to accurately report the inten -\nsity of these sensations. People who are socially anxious often report that their physi -\ncal symptoms are very intense, particularly those symptoms that might be visible to \nother people. This is, however, often not the case. For the majority of people who are", "source": "shyness_social.pdf"}
{"id": "8f8d65eca45f-1", "page_content": "socially anxious, their symptoms are much less noticeable than they think. For example, \na study by Mulkens, de Jong, Dobbelaar, and B\u00f6gels (1999) found that when socially \nanxious individuals are exposed to a stressful social situation, they are more likely than \n nonanxious individuals to believe that they are blushing. However, the study also found", "source": "shyness_social.pdf"}
{"id": "d8e32885d349-0", "page_content": "The Shyness & Social Anxiety Workbook\n18that there were no differences between socially anxious and nonanxious people with \nrespect to the actual intensity of blushing.\nAlthough in most cases people\u2019s anxiety symptoms are less noticeable than they \nthink, there is no question that a small number of individuals have a tendency to blush, \nshake, or sweat that is clearly excessive and may actually be quite noticeable to other \npeople. In other words, some people blush easily and others don\u2019t. Some people have \nshakier hands than others, and some people perspire more than others. However, not \neveryone who blushes, sweats, and shakes excessively also experiences intense fear when \naround other people. In fact, many people are not terribly concerned about experiencing \nthese symptoms in front of other people. \nIn other words, experiencing these symptoms is not the problem. Rather, it is your \nbeliefs about the meaning and possible consequences of these symptoms that contributes \nto your social anxiety. If you didn\u2019t care whether other people noticed your physical \nanxiety symptoms you would probably be much less anxious in social and performance \nsituations. Furthermore, you would probably experience fewer of these uncomfortable \nsymptoms.\nNot surprisingly, the physical sensations that you experience when you are anxious \nor fearful are similar to those that you experience during any intense emotion, including \nexcitement and anger. The differences between fear, excitement, and anger manifest not \nso much in the way they feel physically, but rather in the types of thoughts and behav -\niors associated with each of these emotions. It is to these aspects of social anxiety that \nwe now turn our attention.\nSocial Anxiety and Thinking\nStrictly speaking, people don\u2019t react emotionally to the situations and events in their", "source": "shyness_social.pdf"}
{"id": "d8e32885d349-1", "page_content": "Strictly speaking, people don\u2019t react emotionally to the situations and events in their \nlives. Rather, they react to their beliefs and interpretations concerning these events and \nsituations. In other words, given an identical situation, different people might have com -\npletely different emotional responses, depending on their beliefs about the situation.\nConsider the following example. Imagine that you have interviewed for a job and are \nwaiting to hear about the outcome of the interview. You were told that you would hear \nwithin a week. Two weeks have passed, and you still haven\u2019t heard from anyone about \nwhether you were selected for the position. How would you feel? What emotions would \nyou be experiencing? Well, you might be nervous if you thought the lack of a call was a \nsign that you didn\u2019t get the job. On the other hand, if you thought no call was a sign that \ndecisions had not yet been made, you might feel more optimistic. You might be angry if \nyou believed that the interviewer was treating you disrespectfully by not calling.\nOften our beliefs are accurate; however, sometimes our beliefs are exaggerated or \nincorrect. For example, some people who are socially anxious are quick to assume that \nanother person doesn\u2019t like them just because he or she seems uninterested during a \nconversation. In reality, there are many reasons why a person might look uninterested \nwhen talking to you. Some of these include:", "source": "shyness_social.pdf"}
{"id": "7fbf9f2a02f4-0", "page_content": "Shyness and Social Anxiety\n19U\u00caThe other person is not interested in the topic of the conversation but still \nlikes you as an individual.\nU\u00caThe other person is hungry.\nU\u00caThe other person is in a hurry (for example, he or she is late for an \nappointment).\nU\u00caThe other person is tired.\nU\u00caThe other person is feeling sick or unwell.\nU\u00caThe other person is shy or socially anxious.\nU\u00caThe other person is thinking about something stressful that happened earlier \nin the day.\nU\u00caThe other person is worrying about something that is coming up.\nU\u00caThe other person is someone who generally doesn\u2019t enjoy conversations.\nU\u00caThe other person is someone who always looks somewhat uninterested, \neven when he or she is having a good time.\nU\u00caYou are incorrectly assuming that the other person is uninterested even \nthough he or she is showing all the usual signs of interest.\nIf you are anxious in social situations, the chances are that you are either interpret -\ning the situations as threatening in some way or are predicting that something negative \nis likely to occur. The more often you experience social or performance anxiety, the \nmore often you probably engage in this style of anxious thinking. We will provide a more \ndetailed discussion of the role of thoughts in social anxiety in chapter 6. For now, here \nare common beliefs held by people who are socially anxious:\nU\u00caIt\u2019s essential that everyone likes me.\nU\u00caIf someone doesn\u2019t like me, it means I am unlikable.\nU\u00caIf someone rejects me, I deserve it.\nU\u00caPeople should always be interested in what I am saying.", "source": "shyness_social.pdf"}
{"id": "7fbf9f2a02f4-1", "page_content": "U\u00caPeople should always be interested in what I am saying.\nU\u00caPeople should never have a disapproving or bored look on their face when \nI am talking.\nU\u00caPeople should never talk about me behind my back.\nU\u00caIf I make a mistake at work, I\u2019ll get \ufb01red.", "source": "shyness_social.pdf"}
{"id": "002445c6c20a-0", "page_content": "The Shyness & Social Anxiety Workbook\n20U\u00caPeople will be angry with me if I make a mistake.\nU\u00caI\u2019ll make a fool of myself if I give a presentation.\nU\u00caPeople can tell when I\u2019m nervous.\nU\u00caPeople \ufb01nd me unattractive, boring, stupid, lazy, incompetent, weird, weak, \nand so on.\nU\u00caPeople are untrustworthy, judgmental, and nasty.\nU\u00caI should be able to hide my anxiety symptoms.\nU\u00caIt\u2019s awful to blush, shake, or sweat in front of others.\nU\u00caIf my hands shake at work, it will be a disaster.\nU\u00caAnxiety is a sign of weakness.\nU\u00caI should not appear anxious in front of others.\nU\u00caI won\u2019t be able to speak if I\u2019m too anxious.\nSocial Anxiety and Behavior\nThe most common behavioral response to feeling anxious or frightened is to either \navoid the anxiety-provoking situation completely or to do something else to reduce the \nanxiety as quickly as possible. The reason people engage in these behaviors is because \nthey are very effective at reducing discomfort\u2014 in the short term . However, in the long \nterm, these behaviors have the effect of maintaining fear and anxiety in social situations \nbecause they prevent people from learning that their anxiety-provoking predictions are \nunlikely to come true. Following are some examples of behaviors that people often use to \nreduce their anxiety in social situations. Notice that some of these are examples involv -\ning complete escape or avoidance. However, other examples involve partial  avoidance, \nefforts to reduce anxiety, or attempts to protect oneself in the situation. These behaviors \nare often called safety behaviors , because they are carried out in an effort to feel safer in \nthe feared situation:", "source": "shyness_social.pdf"}
{"id": "002445c6c20a-1", "page_content": "the feared situation:\nU\u00caTurning down an invitation to a party\nU\u00caMaking an excuse not to have dinner with a friend\nU\u00caNever answering questions in class\nU\u00caAlways arriving late for meetings and leaving early in order to avoid making \nsmall talk", "source": "shyness_social.pdf"}
{"id": "3da2a91bd7f9-0", "page_content": "Shyness and Social Anxiety\n21U\u00caOffering to help with the dishes at a party in order to avoid talking to the \nguests\nU\u00caMaking an excuse to get off the telephone with a friend or coworker\nU\u00caDistracting yourself from your anxious thoughts\nU\u00caHaving the room dark during your presentation in order to keep the audi -\nence focused on the slides rather than on you\nU\u00caFilling out a check before arriving at a store in order to avoid having to write \nin front of others\nU\u00caAvoiding eye contact and talking very quietly during conversations with \nothers\nU\u00caWearing makeup and a turtleneck sweater to hide your blushing\nU\u00caAlways attending the of\ufb01ce holiday party with a close friend, spouse, or \nother safe person, even though other guests usually attend alone\nU\u00caAlways arriving for meetings early to ensure that it will not be necessary to \nenter the room after everyone else is already seated\nU\u00caHaving a couple of glasses of wine before meeting another person for a \ndate\nInteractions Among the Three Components\nThe cycle of fear and anxiety can begin with any of the three components we\u2019ve \njust discussed. For example, you may be talking to a colleague at work when you notice \nyourself perspiring slightly (physical component). That may lead to anxious thoughts \nabout whether your colleague is noticing your sweaty brow and wondering if there is \nsomething wrong with you (cognitive component). As your anxiety increases, the inten -\nsity of your physical sensations increases and you continue to think anxious thoughts. \nEventually, you may make an excuse to leave the situation (behavioral component).\nAlternatively, the cycle may begin with the cognitive component. For example,", "source": "shyness_social.pdf"}
{"id": "3da2a91bd7f9-1", "page_content": "Alternatively, the cycle may begin with the cognitive component. For example, \nbefore giving a presentation, you may tell yourself that you are going to lose your train \nof thought and that others will notice how uncomfortable you are. You imagine that the \nothers will interpret your discomfort as a sign of weakness (cognitive component). As \nyou continue to dwell on these anxious thoughts, you notice your face beginning to feel \n\ufb02ushed and your heart rate increasing (physical component). Finally, you make a decision \nto read your presentation word for word to be sure that your anxiety doesn\u2019t cause you \nto lose your place during the presentation (behavioral component).", "source": "shyness_social.pdf"}
{"id": "d2ad18327977-0", "page_content": "The Shyness & Social Anxiety Workbook\n22Finally, the cycle may start with the behavioral component, namely avoidance and \nsafety behaviors. By putting off getting together with friends for a long time (behavioral \ncomponent), you are more likely to experience anxious thoughts (cognitive component) \nabout what might happen when you do see them, as well as uncomfortable physical \nfeelings when you are actually in the situation (physical component). Although avoiding \nanxiety-provoking situations can be comforting in the short term, it also can have the \neffect of making the situation even more uncomfortable when you \ufb01nally confront it. \nThe longer you put off an unpleasant task, the harder it is to start the task when you \n\ufb01nally decide to do it.\nExercise: Components of Social Anxiety\nOver the next week or so, photocopy and use the Three Components of Social Anxiety \nMonitoring Form (found at the end of this chapter) to record your anxiety in terms \nof the three components of fear. Try to complete the form each time you encounter \na feared social situation (if possible, at least three times in the next week). In the \ufb01rst \ncolumn, record the situation (including time and place). In the second column, record \nthe intensity of your fear using a scale from 0 (no fear) to 100 (maximum fear). In the \nthird column, record the physical sensations that you experienced in the situation. In the \nfourth column, record any anxiety-provoking thoughts or predictions that you are aware \nof regarding the situation. Finally, in the \ufb01fth column, record any avoidance behaviors or \nany other anxious behaviors used to reduce your anxiety. In addition to the blank form, \na sample completed form is included.\nOTHER PROBLEMS AND FEATURES", "source": "shyness_social.pdf"}
{"id": "d2ad18327977-1", "page_content": "a sample completed form is included.\nOTHER PROBLEMS AND FEATURES \nSocial anxiety is often associated with other problems. These may include panic attacks \nin social situations, excessively high standards and perfectionism, depressed mood, a \nnegative body image, substance abuse, or dif\ufb01culty trusting others. We will now discuss \neach of these associated dif\ufb01culties. \nPanic Attacks\nIf you experience intense social anxiety, the chances are good that you have had \npanic attacks in social and performance situations. As discussed at the beginning of \nthis chapter, a panic attack is a rush of fear that occurs in the absence of any realistic \ndanger. According to the de\ufb01nition of a panic attack, the fear must peak within ten", "source": "shyness_social.pdf"}
{"id": "840e8bf29048-0", "page_content": "Shyness and Social Anxiety\n23minutes, although it usually peaks immediately or within a few seconds. Also, to meet \nthe full criteria for a panic attack, there must be at least four symptoms from a list \nof thirteen, including racing heart, chest discomfort, dizziness, breathlessness, shaking, \nstomach discomfort, sweating, choking feelings, hot \ufb02ashes or chills, feelings of unreality \nor  detachment, numbness or tingling, and fears of dying, going crazy, or losing control.\nFor those who suffer from social anxiety, panic attacks tend to be triggered by \nexposure to feared social situations or even just thinking about being in a feared situa -\ntion. In addition, people who are socially anxious are often fearful of experiencing panic \nsymptoms. Because panic-attack symptoms are often incorrectly viewed as a sign that \none is about to lose control, it\u2019s no wonder that people who are socially anxious would \nwant to avoid having panic attacks in front of others. Even though people who experi -\nence panic attacks often are afraid of losing control, going crazy, fainting, having a heart \nattack, or experiencing some other physical or social catastrophe, such consequences \nare extremely unlikely. In other words, panic attacks are uncomfortable, but they aren\u2019t \ndangerous. In fact, the symptoms often are not even noticeable to other people.\nPerfectionism\nResearch from our organization (Antony et al. 1998) and elsewhere has found that \nsocial anxiety is associated with elevated levels of perfectionism. Perfectionists hold \n standards that are unrealistically high and overly rigid. They may have exaggerated con -\ncerns about making mistakes and often go out of their way to ensure that mistakes are \navoided.\nIn social anxiety, people tend to place too much importance on making a perfect", "source": "shyness_social.pdf"}
{"id": "840e8bf29048-1", "page_content": "In social anxiety, people tend to place too much importance on making a perfect \nimpression on others. If they are not guaranteed to be approved of by others, they may \nfeel very anxious in social situations or avoid socializing altogether. Perfectionism is \ndifferent from simply having high standards. High standards are often useful because \nthey motivate us to work hard and succeed. In the case of perfectionism, however, the \nstandards are so high and so in\ufb02exible that they actually interfere with performance by \ncausing a person to overprepare for tasks (for instance, spending hours rehearsing a pre -\nsentation), procrastinate (such as putting off preparing for a presentation), or be overly \ncritical of his or her own performance.\nDepression\nGiven the impact of social anxiety on a person\u2019s functioning, it is no wonder that \na substantial number of people with social anxiety disorder also experience depression. \nSevere social anxiety can lead to isolation, loneliness, and deep sadness. Social anxiety \ndisorder can prevent a person from living up to his or her potential, which, in turn, can \nlead to feelings of hopelessness and depression. Depression can also increase the severity \nof social anxiety.", "source": "shyness_social.pdf"}
{"id": "a06616b87cc2-0", "page_content": "The Shyness & Social Anxiety Workbook\n24People who are depressed are often embarrassed about feeling down, may assume \nthat others don\u2019t want to be around them, and may avoid being around other people. \nSocial anxiety and depression are associated with similar thought patterns as well\u2014\nspeci\ufb01cally, negative thoughts about oneself and about one\u2019s relationships. Finally, there \nis reason to think that social anxiety disorder and depression may be related to similar \nbiological processes in the brain. In fact, the treatments discussed in this book (including \nboth psychological treatments and medications) have been shown to be useful for both \nanxiety and depression.\nBody Image Problems\nPeople who are unhappy with their physical appearance may feel anxious when \nsocializing or being watched by others. For example, people with eating disorders such \nas anorexia nervosa and bulimia nervosa may avoid activities that involve eating in front \nof others or showing their bodies (such as wearing shorts, swimming, or exercising in \npublic). People who are overweight may also be concerned about having their physical \nappearance judged negatively by others. In fact, dissatisfaction with any aspect of one\u2019s \nphysical appearance (for example, losing your hair, not liking your nose, and so on) can \nlead some people to experience social anxiety.\nSubstance Abuse \nSome people who experience excessive levels of social anxiety use alcohol or other \ndrugs to help cope with social situations. In most cases, this may involve only having an \nextra glass of wine at a party or having a beer when eating out with friends. However, \nfor some people, using alcohol or drugs to manage anxiety can become a problem if \nthe drug or alcohol use becomes excessive. If you frequently use excessive amounts of \nalcohol or other drugs to feel more comfortable in social situations, it may be important", "source": "shyness_social.pdf"}
{"id": "a06616b87cc2-1", "page_content": "alcohol or other drugs to feel more comfortable in social situations, it may be important \nto address this issue at the same time that you are working on your social anxiety.\nAnger and Mistrust of Others\nIn addition to fearing negative judgment from others, some people with high levels \nof social anxiety may also have dif\ufb01culty trusting others. They may avoid con\ufb01ding \nin others, not only for fear of being judged, but also because they\u2019re afraid that other \npeople will not be able to keep a secret. Social anxiety is also sometimes associated with \nelevated levels of anger and irritability. For example, some people with social anxiety \ndisorder may become very angry or hostile when being looked at by others. They may \nalso become angry at perceived rejections by other people.", "source": "shyness_social.pdf"}
{"id": "7cea094fbb54-0", "page_content": "Shyness and Social Anxiety\n25OVERCOMING SOCIAL ANXIETY\nTwo general approaches have been shown to be useful for overcoming social anxiety: \npsychological strategies and medications. We\u2019ll discuss each of these brie\ufb02y. \nPsychological Strategies\nAlthough there are many different types of psychotherapy practiced by mental \nhealth professionals, there are only a small number of strategies that have been shown to \nbe effective for reducing social anxiety in a relatively brief amount of time. The chapters \nin this book discuss three general approaches that repeatedly have been shown to be \neffective for treating social anxiety disorder:\n1. Exposure-based strategies will teach you to approach feared situations grad -\nually, over and over again, until they no longer provoke fear. \n2. Cognitive strategies will be used to help you to identify your anxiety-  provoking \nthoughts and to replace them with more realistic ways of thinking.\n3. Instruction in basic communication skills will teach you to communicate \nmore assertively, meet people more easily, give effective presentations, and \nuse nonverbal communication appropriately.\nMedications\nThere are a number of medications that have been shown to be effective for decreas -\ning social anxiety. These include a range of antidepressants as well as certain tranquil -\nizers. As long as the person continues to take the medication, these treatments are about \nas effective as the psychological strategies discussed in this book. For some people, the \ncombination of medication and psychological treatment is the most effective approach. \nIn chapter 5 we will discuss the bene\ufb01ts and costs of using particular medications for \ntreating your social anxiety.", "source": "shyness_social.pdf"}
{"id": "c96aa2c8e14f-0", "page_content": "The Shyness & Social Anxiety Workbook\n26\nThree Components of Social Anxiety Monitoring Form\nPlace/Situation/TimeFear \n(0\u201300)Physical Feelings Anxiety-Provoking Thoughts Anxious Behaviors", "source": "shyness_social.pdf"}
{"id": "2ced573ae374-0", "page_content": "Shyness and Social Anxiety\n27Three Components of Social Anxiety Monitoring Form\u2014Completed Sample\nPlace/Situation/TimeFear \n(0\u2013100)Physical Feelings Anxiety-Provoking Thoughts Anxious Behaviors\nAt a party on Tuesday night; \nI said to Mike, \u201cIt\u2019s been ages \nsince I saw you last,\u201d and he \nresponded by reminding me \nthat I just saw him last week!90 Heart racing, sweating, \nshaking, short of breathI can\u2019t believe I said that! Mike must \nthink I\u2019m an idiot for forgetting that I \njust saw him. Maybe he thinks I don\u2019t \ncare enough to remember him. He must \nnotice that I am a nervous wreck!Apologized to Mike about 5 times, and \nthen went to the bathroom to get away \nfrom him. After about 10 minutes, I \nmade an excuse and left the party.\nWednesday evening. Preparing \nfor a brief  \npresentation on Friday.70 Heart racing, muscle tightness I will lose my train of thought. People \nwill think I am incompetent. I will lose \nmy job if I blow this presentation.  \n Had two glasses of wine to calm down. \nRehearsed my presentation about 20 \ntimes. Asked a coworker to present with \nme.\nSaturday afternoon. Walking \nthrough the mall.50 Feeling \ufb02ushed, palms are \nsweaty, heart is racingPeople are staring at me. They can tell \nI\u2019m anxious. They are probably think -\ning I look funny or that I walk funny.  \n I avoided eye contact with other people. \nAfter about 5 minutes, left the mall, \neven though I hadn\u2019t \ufb01nished my \nshopping!", "source": "shyness_social.pdf"}
{"id": "069e88fda38e-0", "page_content": "CHAPTER 2\nWhy Do You Have  \nThese Fears?\nBIOLOGICAL FACTORS\nAs with any emotion or personality trait, our biology affects the tendency to experience \nanxiety in social situations (Mathew and Ho 2006). Biological processes such as natural \nselection or evolution, genetics, brain activity, and alterations in the levels of certain \nneurotransmitters in the brain may all contribute to social anxiety. We\u2019ll discuss each of \nthese in this section.\nNatural Selection: The Evolutionary Function of  \nSocial Anxiety\nNatural selection is the process by which members of a species who are best able \nto adapt to their environments are the most likely to reproduce successfully, thereby \ncausing the species to evolve gradually and to survive over a long period of time. It \nmakes sense that through natural selection, those among us who are most \ufb01t and healthy \nmight be more likely to survive and to reproduce than those who are less so. However, \nseveral authors have argued that many of the illnesses  from which humans suffer may also", "source": "shyness_social.pdf"}
{"id": "9551c461b8f3-0", "page_content": "The Shyness & Social Anxiety Workbook\n30have developed according to the same laws of natural selection that are thought to have \nguided the more \u201cpositive\u201d aspects of human evolution (Moalem and Prince 2007; Nesse \nand Williams 1994).\nFor example, in their book, Why We Get Sick: The New Science of Darwinian Medicine , Drs. \nRandolph Nesse and George Williams discuss how a number of uncomfortable condi -\ntions such as sneezing from allergies, suffering from colds or fevers, and experiencing \npain from injuries all serve to protect us from potential dangers. The same processes that \nlead to allergies, colds, and fever also help the body to rid itself of potentially danger -\nous toxins and parasitic viruses. Likewise, pain following an injury is a warning sign that \nprevents us from moving our bodies in ways that could worsen the injury.\nMight anxiety also improve our chances of survival? As we mentioned in chapter \n1, the \ufb01ght-or-\ufb02ight response associated with fear and panic protects us from potential \ndanger. When we are afraid, our bodies quickly become mobilized either to meet the \ndanger head on or to escape from the danger as quickly as possible. All of the sensations \nthat we experience when we are frightened (for instance, increased pulse, faster breath -\ning, sweating, hyperventilation, and so on) are designed to help us meet the physical \ndemands of confronting the threat (\ufb01ghting) or escaping to safety (\ufb02ight).\nFrom an evolutionary perspective, it makes sense that we humans would develop \na propensity for experiencing social anxiety. We are social beings, and as such, we are \nvery much dependent on those around us. None of us could survive without the help of", "source": "shyness_social.pdf"}
{"id": "9551c461b8f3-1", "page_content": "very much dependent on those around us. None of us could survive without the help of \nothers. As infants and children, we are completely dependent on our parents for food, \nshelter, comfort, and education. As we grow up, we continue to depend on other people. \nWe depend on our employers to provide us with money for food and shelter. We depend \non other people to build our homes, grow our food, heal our injuries, entertain us, \nand to help us meet most of our day-to-day needs. Because of our dependence on one \nanother, we learn at a very young age that it is important to get along well with people. \nEssentially, we want other people to like us. After all, consistently making a bad impres -\nsion on other people might lead to isolation, unemployment, and many other negative \nconsequences.\nFeeling anxious in social situations serves to remind each of us to pay attention to \nthe effects our behavior has on those around us. If we didn\u2019t think about the impact of \nour behavior on others, we would probably get into trouble more often than not. We \nwouldn\u2019t bother dressing nicely or being polite. We might always say exactly what\u2019s on \nour mind without considering whether it might be hurtful. Feeling anxious in social \nsituations protects us from offending other people and from doing things that might \nlead others to judge us in negative ways. So, not only is it normal to feel shy or socially \nanxious from time to time, it is also helpful.\nOf course, social anxiety and shyness are not always helpful. Extreme social anxiety \nmay lead to impaired concentration, which, in turn, can cause a person to make more \nerrors at work or school. In addition, socially anxious people often avoid taking social", "source": "shyness_social.pdf"}
{"id": "9551c461b8f3-2", "page_content": "errors at work or school. In addition, socially anxious people often avoid taking social \nrisks and may therefore \ufb01nd it dif\ufb01cult to make friends or to \ufb01nd work. Whereas mild to \nmoderate levels of social anxiety are completely normal and potentially helpful, extreme \nsocial anxiety can interfere with a person\u2019s functioning.", "source": "shyness_social.pdf"}
{"id": "df83b63cb48f-0", "page_content": "Why Do You Have These Fears?\n31So, from an evolutionary perspective, people with social anxiety disorder do not \nhave an illness,  per se. Rather, they have too much of a good thing . Social anxiety is helpful in \nsmall doses, but when it is too intense, it can make life more dif\ufb01cult.\nGenetics and Social Anxiety\nSocial anxiety disorder appears to run in families. For example, a study by Stein, \nChartier, Hazen, Kozak, et al. (1998) found that having a close relative (for example, a \nparent, sibling, or child) with generalized  social anxiety disorder (extreme anxiety in most \nsocial situations) made an individual ten times as likely to have social anxiety disorder, \ncompared with individuals who didn\u2019t have a socially anxious relative. In contrast, more \nnarrowly focused social fears (for example, a fear of public speaking only) were less likely \nto run in families. \nOf course, the existence of social anxiety disorder in multiple family members does \nnot necessarily mean that the social anxiety is transmitted by genes. Environmental \nfactors (for example, learning from one\u2019s parents and siblings) can also contribute to \nthe family members sharing certain behaviors and tendencies. To tease out the effects \nof genetic in\ufb02uences from the effects of environment and learning, scientists have relied \non three main types of studies:\n1. Twin studies.  Twin studies examine the frequency of a problem across pairs \nof identical twins  (twins who are 100 percent genetically identical) vs. pairs of \nfraternal twins  (twins who share, on average, 50 percent of their genetic mate -\nrial). Because twin pairs tend to be raised in similar environments regardless", "source": "shyness_social.pdf"}
{"id": "df83b63cb48f-1", "page_content": "rial). Because twin pairs tend to be raised in similar environments regardless \nof whether they are identical twins or fraternal twins, a higher social anxiety \nconcordance rate in identical twins than in fraternal twins is thought to be \nevidence that genetics may have played a larger role in the development of \nthe social anxiety (the term concordance rate  refers to the probability of one \nperson having a particular problem if his or her twin also has the problem).\n2. Adoption studies . In adoption studies, scientists interview both the bio -\nlogical parents and the adoptive parents of people who were adopted as \nchildren and who also have the particular problem being studied. If the \nresearcher \ufb01nds that social anxiety disorder occurs much more frequently in \nthe biological parents of the socially anxious adoptees than in the adoptive \nparents, it suggests that genetics may be more important than environment. \nAlthough adoption studies have been used to study the role of genetics \nin various disorders and illnesses, this approach has not yet been used in \nresearch on social anxiety disorder.\n3. Molecular genetics studies . In 2003, scientists completed the Human \nGenome Project, which involved mapping all of the genes in human DNA \nand determining the sequences of the 3 billion chemical base pairs that", "source": "shyness_social.pdf"}
{"id": "85ff3e5e111b-0", "page_content": "The Shyness & Social Anxiety Workbook\n32make up human DNA. This work has made it possible for scientists to study \nparticular genes that may be involved in the development of social anxiety \ndisorder and many other conditions, using research methods known as \nlinkage studies  and association studies .\nSo, what do we know about the role of genetics in social anxiety disorder? Most of \nthe studies to date on genetics and social anxiety disorder have been twin studies (for \ninstance, Kendler, Karkowski, and Prescott 1999; Kendler et al. 2001; Stein, Jang, and \nLivesley 2002), and there has also been a small number of molecular genetics studies (for \nexample, Lochner et al. 2007). Generally, twin studies have found modest to moderate \nlevels of heritability for social anxiety disorder, suggesting that although genetics plays a \nrole, other factors such as a person\u2019s environment and experiences are also very impor -\ntant. Molecular genetics studies are just beginning in the area of social anxiety, and over \ntime they should help to uncover which genes are most important in the development \nof this problem.\nTwo personality traits closely related to social anxiety appear to be heritable as well, \nwith heritability estimates  (the extent to which the transmission of a trait across generations is \ndue to genetics) being close to 50 percent across a wide range of studies (Plomin 1989). \nOne of these traits, called neuroticism , is a general tendency to feel distressed, anxious, \nnervous, and worried. The other trait, called introversion , is a tendency to be inwardly \nfocused and socially withdrawn. Not surprisingly, shyness and social anxiety tend to be", "source": "shyness_social.pdf"}
{"id": "85ff3e5e111b-1", "page_content": "focused and socially withdrawn. Not surprisingly, shyness and social anxiety tend to be \nassociated with both of these personality styles (Briggs 1988). Recently, researchers have \nstarted to use molecular genetics studies to identify speci\ufb01c genes that may contribute \nto traits such as introversion (Stein, Schork, and Gelernter 2004).\nIf genetics does play a role in causing social anxiety, does that mean that social \nanxiety cannot be changed? Not at all. Our genetic makeup affects just about every \naspect of who we are, including physical \ufb01tness, academic ability, depression, weight, \npersonality, and even our interests and hobbies. Yet we all know that our behavior and \nexperiences still play an important role in determining our behavior and performance in \nthese various domains.\nFor example, regardless of whether you are genetically predisposed to be athletic, \ntraining hard will improve your athletic ability. Furthermore, the environment (for \nexample, the exercise habits that you learn while growing up) may have a profound effect \non whether you exercise regularly as an adult. Still, there are differences between people \nwith respect to how hard they must train to become physically \ufb01t. For some people, it \ncomes easier than for others\u2014in part, because of their genetic makeup.\nThe same reasoning holds true for social anxiety. A genetic predisposition to have \nhigh levels of social anxiety and shyness simply means that you may have to work harder \nat overcoming the problem than someone who doesn\u2019t have such a tendency.", "source": "shyness_social.pdf"}
{"id": "ae30197789a4-0", "page_content": "Why Do You Have These Fears?\n33Effects of the Brain and Neurotransmitters\nCompared with other psychological problems, including other anxiety disorders, \nstudies examining the biological factors underlying social anxiety often have failed to \nobtain signi\ufb01cant \ufb01ndings. For example, research examining hormonal factors, sleep pat -\nterns, and heart functioning has often failed to \ufb01nd differences between people with \nsocial anxiety disorder and people without signi\ufb01cant social anxiety. \nHowever, a number of studies have found increased levels of activity in particular \nparts of the brain during periods of social anxiety. For example, scientists have found \nthat people with social anxiety disorder experience increased activity in a part of the \nbrain called the amygdala  when looking at pictures of harsh faces (Phan et al. 2006; Stein \net al. 2002; Straube et al. 2004). The amygdala is part of the limbic system  and is activated \nwhen we experience the emotion of fear. During public speaking, there also appears \nto be more activation in the amygdala among people with social anxiety disorder than \namong people without this problem (Phan et al. 2006).\nAs reviewed by Britton and Rauch (in press), other areas of the brain that have been \nfound to be activated during social anxiety include the anterior  cingulate cortex  (an area that \nis involved in controlling emotions, thought, and heart rate, among other functions), the \nmedial prefrontal cortex  (a section of the brain that is involved in complex cognition, per -\nsonality expression, and social behavior), the insular cortex  (a section of the limbic system \nthat is involved in the experience of basic emotions, including fear), and the hippocampus", "source": "shyness_social.pdf"}
{"id": "ae30197789a4-1", "page_content": "that is involved in the experience of basic emotions, including fear), and the hippocampus  \n(a part of the limbic system that controls memory and spatial abilities). Furthermore, \ntreatment of social anxiety with either cognitive behavioral therapy or medication leads \nto  reductions in activity in the amygdala and hippocampus (Furmark et al. 2002).\nStudies examining the role of neurotransmitters (the chemicals responsible for \n transmitting information throughout the brain) in social anxiety have yielded mixed \nresults (McCabe and Antony, in press). Some studies suggest that the neurotransmitter \ndopamine  may be involved in social anxiety, whereas other studies have failed to replicate \nthese \ufb01ndings. Studies regarding the role of serotonin (another neurotransmitter) have \nalso yielded mixed \ufb01ndings. However, medications that work on the serotonin system \nhave consistently been found to be helpful for decreasing the symptoms of social anxiety \ndisorder (more on this in chapter 5).\nPSYCHOLOGICAL FACTORS\nIn addition to biology, people\u2019s experiences and beliefs also contribute to whether they \ndevelop dif\ufb01culties with social anxiety and shyness. The ways in which learning and \nbeliefs contribute to social anxiety are discussed in this section.", "source": "shyness_social.pdf"}
{"id": "0f57cdc9cfaa-0", "page_content": "The Shyness & Social Anxiety Workbook\n34How Learning Contributes to Social Anxiety\nA large number of studies suggests that learning plays an important role in the \ndevelopment of fear. We learn to fear objects and situations through three main routes \n(Rachman 1976). First, directly experiencing a trauma or some negative consequence in \na particular situation can lead to fear. For example, being bitten by a dog can teach a \nperson to be afraid of dogs. Second, observing other people who are afraid of a situation \ncan teach a person to be nervous. So, people may be more nervous behind the wheel \nof a car if they grew up with a parent who was an anxious driver. Finally, hearing or \nreading about the dangers of a particular situation can help to cause or maintain a per -\nson\u2019s fear. For instance, reading about airline crashes can help to strengthen a person\u2019s \nfear of \ufb02ying.\nLEARNING BY DIRECT EXPERIENCE\nA history of negative experiences in social situations can increase a person\u2019s shyness \nand social anxiety. For example, in a study from our center, people with social anxiety \ndisorder were more likely to describe a history of severe teasing in childhood than were \npeople with other anxiety problems (McCabe et al. 2003). In addition to teasing, other \nexamples of social traumas include:\nU\u00caBeing bullied by other children while growing up\nU\u00caHaving parents, friends, teachers, or employers who are overly critical\nU\u00caDoing something embarrassing in a social situation (such as making an \nobvious mistake, vomiting, having a panic attack, and so on)\nIn the space below, list examples of negative consequences that you have experi -\nenced in social situations that may have contributed to or helped to maintain your social \nanxiety.", "source": "shyness_social.pdf"}
{"id": "0f57cdc9cfaa-1", "page_content": "anxiety.\nExamples of Negative or \u201cTraumatic\u201d Experiences That May Have Contributed to \nMy Social Anxiety", "source": "shyness_social.pdf"}
{"id": "9daf18b63412-0", "page_content": "Why Do You Have These Fears?\n35LEARNING BY OBSERVING OTHERS\nObservation is a powerful way of learning to fear speci\ufb01c objects and situations. This \nform of learning (also called vicarious  learning ) includes developing a fear by observing role \nmodels who themselves are anxious in social situations. Another form of observational \nlearning involves witnessing another person experience a trauma in a social situation. \nExamples of observational learning experiences that could lead to the development of \nsocial anxiety include:\nU\u00caGrowing up with family members who are very shy and who rarely \nsocialize\nU\u00caWatching a classmate be severely criticized by a teacher following a \npresentation\nU\u00caSeeing coworkers become very anxious while giving presentations\nU\u00caWitnessing a friend being teased by other students at school\nIn the space below, list examples of observational learning experiences that may have \ncontributed to or helped to maintain your social anxiety.\nExamples of Observational Learning Experiences That May Have Contributed to \nMy Social Anxiety\nLEARNING THROUGH INFORMATION AND INDIRECT MEANS\nPeople can learn to fear social situations by reading about or being warned about the \ndangers of making a bad impression on others. Examples of situations that could lead to \ndeveloping social anxiety through the transmission of information include:\nU\u00caBeing repeatedly told by parents that it is very important to always make a \ngood impression\nU\u00caBeing exposed to messages in magazines and on television that your image \nis the most important thing about you, and that you are only as attractive \nas other people think you are", "source": "shyness_social.pdf"}
{"id": "4c6b1b735879-0", "page_content": "The Shyness & Social Anxiety Workbook\n36In the space below, list examples of informational learning experiences that may have \ncontributed to, or helped to maintain, your social anxiety.\nExamples of Indirect or Informational Learning Experiences That May Have \nContributed to My Social Anxiety\nWhy Only Some People Develop Extreme Social Anxiety\nAlthough negative experiences, observational learning, and informational learning \nare common routes by which people develop fears, they are not enough to explain why \nsome people develop social anxiety and others don\u2019t. Almost everyone is exposed to \nnegative experiences in social situations. At one time or another most of us are teased. \nWe are all exposed to anxiety-provoking messages at home, as well as through the media. \nAnd yet, not everyone develops a problem with social anxiety. Why is this so?\nMost likely, there are other factors that in\ufb02uence whether a particular person devel -\nops problems with social anxiety following a history of negative social experiences. These \ncan include biological factors, such as a person\u2019s genetic makeup. Previous learning expe -\nriences and the ways in which someone deals with his or her negative social experiences \nmay also in\ufb02uence the development of fear. For example, a person who is ridiculed the \n\ufb01rst time he or she gives a presentation may be more likely to develop a fear of public \nspeaking than someone who is ridiculed on a single occasion after having given many \nsuccessful presentations previously. Similarly, someone who is severely teased at school \nmay be protected from developing problems with social anxiety if he or she receives \nsupport from close friends after the episode. \nFinally, avoiding a social situation following a traumatic experience may increase the \nchances of developing social anxiety. You have probably heard that the best thing to do", "source": "shyness_social.pdf"}
{"id": "4c6b1b735879-1", "page_content": "chances of developing social anxiety. You have probably heard that the best thing to do \nafter falling off a horse is to get back on as soon as possible to avoid developing a fear of \nhorses. The same is true of social anxiety. If you avoid a social situation following a trau -\nmatic experience, you may increase your chances of developing a fear of that situation.", "source": "shyness_social.pdf"}
{"id": "0c1ea0a41749-0", "page_content": "Why Do You Have These Fears?\n37HOW BELIEFS CONTRIBUTE TO  \nSOCIAL ANXIETY\nAs discussed in chapters 1 and 6, people with elevated social anxiety tend to think about \nsocial situations in a more negative way than do those people who are less anxious. \nAnxiety-provoking thoughts, interpretations, and predictions can lead someone to feel \nfear and anxiety in social situations.\nThere are numerous studies investigating the role of thinking in social anxiety. There \nis also evidence that helping people to change their anxious beliefs is an effective way \nof decreasing their social anxiety. Research on thinking and social anxiety is reviewed \nelsewhere (Antony and Swinson 2000; Hirsch and Clark 2004). Some of the highlights \nof this research include the following \ufb01ndings:\nU\u00caPeople who experience high social anxiety rate negative social events as \nmore likely to occur and more costly (in terms of their consequences), in \ncomparison with people who don\u2019t have signi\ufb01cant social anxiety.\nU\u00caThese people tend to interpret their own performance (such as during a \nconversation or a speech) more critically than do people who are lower in \nsocial anxiety.\nU\u00caThey tend to overestimate the extent to which their physical symptoms \n(such as blushing) are visible to others.\nU\u00caThey are more likely than less anxious people to assume that others will \ninterpret their physical symptoms (shaking, sweating, and so on) as a sign \nof a serious problem with anxiety or some mental illness. In contrast, people \nwho are not socially anxious are less concerned about others noticing their \nphysical arousal symptoms. Instead, people without signi\ufb01cant social anxiety \nassume that others will interpret their physical symptoms as normal (perhaps", "source": "shyness_social.pdf"}
{"id": "0c1ea0a41749-1", "page_content": "assume that others will interpret their physical symptoms as normal (perhaps \na sign of feeling hot, being hungry, and so on).\nU\u00caWhen presented with an ambiguous social situation (for example, a stare \nfrom someone else or a phone call that isn\u2019t returned), people with ele -\nvated social anxiety have a heightened tendency to interpret the situation \nnegatively.\nU\u00caSocial anxiety is associated with a tendency to rate ambiguous or neutral \nfaces as having a more negative expression.\nU\u00caCompared with people who are less anxious, people with social anxiety dis -\norder tend to pay more attention to information that represents social threat \nthan to nonthreatening information. For example, when asked to look at lists \nof words, people who are socially anxious spend more time looking at words", "source": "shyness_social.pdf"}
{"id": "4df0073d10ce-0", "page_content": "The Shyness & Social Anxiety Workbook\n38that are related to social anxiety (words such as \u201cblush\u201d or \u201cparty\u201d) than do \nthose who are less anxious.\nU\u00caSocial anxiety is associated with a tendency to have a better memory and \nrecognition for other people\u2019s faces, particularly if the expression on the \nface appears to be negative or critical.\nTaken together, these studies suggest that social anxiety and social anxiety disorder \nare associated with thinking styles that may actually make the problem worse. In chapter \n6, we\u2019ll discuss ways to change your anxious thoughts and replace them with less anxious \nand more realistic ways of thinking. A number of studies investigating the effects of \ncognitive behavioral therapy on the negative thinking styles often associated with social \nanxiety have found that treatment leads to a reduction in negative thinking (Hirsch and \nClark 2004).\nHOW BEHAVIORS CONTRIBUTE TO  \nSOCIAL ANXIETY\nAs discussed in chapter 1, avoidance of social situations can have the effect of increas -\ning social anxiety over the long term. In other words, the strategy that people who \nare socially anxious use most frequently to cope with their fear may actually make the \nproblem worse .\nIn addition, some behaviors that people use to protect themselves in social situa -\ntions can actually lead to the very outcome that people with social anxiety disorder fear \nmost\u2014a negative reaction from others. For example, if when talking to other people at \na party, you speak very quietly, avoid eye contact, and avoid expressing your views and \nopinions, people may choose to talk to someone else. They may interpret your behavior \nas a sign that you\u2019re not interested in talking or that you are a dif\ufb01cult person to get", "source": "shyness_social.pdf"}
{"id": "4df0073d10ce-1", "page_content": "to know. See chapters 7 through 9 for a discussion of strategies for confronting feared \nsituations instead of avoiding them and for stopping the safety behaviors that help to \nmaintain your fear over time. And, in chapter 10, we\u2019ll discuss strategies for improving \ncommunication and social skills.", "source": "shyness_social.pdf"}
{"id": "f42f76bab7bd-0", "page_content": "CHAPTER 3\nGetting to Know Your  \nSocial Anxiety\nWHY CONDUCT A SELF-ASSESSMENT?\nThe initial step that a psychologist, psychiatrist, or other mental health professional \ntakes in beginning to help an individual with a particular problem is a period of evalua -\ntion and assessment. This evaluation process involves collecting information needed to \nbetter understand the nature and extent of the problem so that the best possible treat -\nment plan can be formulated. This initial assessment almost always involves an interview \nand may also include various questionnaires and standard tests. Sometimes, the therapist \nmay ask the person to start keeping a diary to monitor speci\ufb01c thoughts or behaviors.\nIn the case of social anxiety, a clinician might spend the \ufb01rst session (or even the \n\ufb01rst few sessions) asking questions about the client\u2019s social anxiety, about other dif\ufb01cul -\nties he or she might be experiencing, and about the person\u2019s general background and \nlife experiences. The individual also may be asked to answer a series of questionnaires \nthat measure social anxiety and related problems. In addition, the client is often asked \nto complete diary entries between sessions to measure the person\u2019s anxiety in social \nsituations, his or her feelings of depression, and any other aspects of the problem. The \nassessment process helps the clinician to understand the person\u2019s problems and is useful \nfor choosing an appropriate course of treatment. In addition, repeating certain assess -\nments from time to time allows the clinician to measure whether treatment is working \n(Antony and Rowa 2005).", "source": "shyness_social.pdf"}
{"id": "533ed3e5dabe-0", "page_content": "The Shyness & Social Anxiety Workbook\n40In the same way, a detailed self-assessment will help you to understand and address \nyour dif\ufb01culties with social anxiety. We strongly recommend that, before you begin \nworking on changing your own social anxiety, you carry out a careful self-assessment. \nThis assessment process will have the following four main bene\ufb01ts. It will:\n1. Allow you to measure the severity of your social anxiety\n2. Help you to identify key problem areas\n3. Make it easier to choose the most appropriate treatment strategies\n4. Provide you with an opportunity to measure your improvement as you use \nthe strategies described in this book\nNow we will discuss each of these issues in greater detail.\nMEASURING THE SEVERITY OF YOUR  \nSOCIAL ANXIETY\nThe term \u201cseverity\u201d takes into account such variables as (1) the intensity of your fear in \nsocial and performance situations, (2) the range of different situations that precipitate \nyour social anxiety, (3) the frequency with which you experience intense social anxiety, \n(4) the effect of your social anxiety on your day-to-day life, career, and relationships, \nand (5) the extent to which being socially anxious bothers you. Generally, as the sever -\nity of social anxiety increases, typically, so does the intensity of the fear, the number of \nsituations that are affected, the frequency with which anxiety is experienced, the level of \ninterference with day-to-day functioning, and the extent to which a person is bothered \nby having the fear.\nIDENTIFYING WHICH PROBLEMS TO WORK ON\nIf you\u2019re like many people, you probably experience anxiety in a number of different \nsocial situations. A comprehensive self-assessment will help you to decide which fears", "source": "shyness_social.pdf"}
{"id": "533ed3e5dabe-1", "page_content": "social situations. A comprehensive self-assessment will help you to decide which fears \nto work on \ufb01rst. First, it will be important to identify which situations you fear and \navoid. Next, you will need to identify your priorities\u2014that is, which aspects of the \nproblem you want to begin to address \ufb01rst. When choosing your priorities, here are \nsome  suggestions to keep in mind:\nU\u00caBegin working on problems for which you are likely to see quick changes. \nEarly improvements will help to motivate you to work on more dif\ufb01cult \nsituations.", "source": "shyness_social.pdf"}
{"id": "ad27c0773af8-0", "page_content": "Getting to Know Your Social Anxiety\n41U\u00caTry to work on fears that interfere the most with your day-to-day life. Being \nable to confront the most disabling fears will have a much bigger impact on \nyour life than working on fears that are less important to you.\nU\u00caIf one of your treatment aims is very important to you but is just too over -\nwhelming to deal with, divide that goal into smaller, more manageable \nobjectives. For example, if you are afraid of dating, you could work on your \nfear by breaking the situation down into steps such as saying hello to an \nattractive classmate, sitting beside the classmate for several weeks in a row, \nspeaking with the classmate after class, offering to study with the classmate, \nand asking the classmate to have dinner with you after class.\nCHOOSING THE BEST STRATEGIES FOR CHANGE\nA self-assessment also can help you to decide which treatment strategies to use. In many \ncases, the speci\ufb01c treatment approaches you select will be directly related to factors you \nidentify in your self-assessment. Consider the following examples of how an assessment \ncan help you to select the best approaches for treatment:\nU\u00caIdentifying which situations you fear and avoid will help you to choose \nwhich situations to select for exposure practices (as described in chapters \n7 and 8).\nU\u00caIdentifying the extent to which you are fearful of the physical feelings that \nyou experience when you are anxious will help determine whether you \nshould practice exposure to uncomfortable physical sensations (as described \nin chapter 9).\nU\u00caAssessing those areas in which your social skills can be improved will help \nyou to decide whether to spend time working on the skills involved in asser -", "source": "shyness_social.pdf"}
{"id": "ad27c0773af8-1", "page_content": "you to decide whether to spend time working on the skills involved in asser -\ntiveness, public speaking, dating, or general communication. (See chapter \n10 for strategies for improving various types of social and communication \nskills.)\nU\u00caIf you decide to take medications for your social anxiety, the choice of \nwhich medication to try will depend on your previous response to medica -\ntions, possible interactions with other medications you take, medical condi -\ntions you may have, side effects that you are willing to tolerate, as well as a \nnumber of other factors. If you are considering using medications, thinking \nabout these issues should be part of your self-assessment (see chapter 5).", "source": "shyness_social.pdf"}
{"id": "b80ae84be335-0", "page_content": "The Shyness & Social Anxiety Workbook\n42MEASURING YOUR IMPROVEMENT\nAssessment is not only for the initial phase of your treatment. Rather, the process of \nassessment should continue throughout treatment and even after treatment has ended. \nContinuing the assessment process throughout treatment will provide you with a way of \nmeasuring how much your social anxiety has improved as a result of using the strategies \ndescribed in this book. Also, conducting occasional self-assessments after treatment has \nended will let you know whether your treatment gains have continued over time.\nSTEP-BY-STEP GUIDE FOR CONDUCTING  \nA SELF-ASSESSMENT\nTherapists and clinicians who treat social anxiety use a number of tools to assess clients \nand patients. The most common of these include the following.\nClinical Interviews \nInterviews involve asking a person speci\ufb01c questions about his or her background, \nanxiety symptoms, and related problems. It is an easy way of getting to know someone \nand learning about his or her dif\ufb01culties simply by talking.\nQuestionnaires \nQuestionnaires include paper-and-pencil tests that a person completes before begin -\nning treatment, and perhaps again during treatment and after treatment ends. They are \nused to provide additional information not covered in the interview, as well as to con\ufb01rm \nand expand upon the information provided in the interview.\nDiaries \nDiaries are completed on a day-to-day basis between therapy sessions. They are \nuseful because they provide the individual with an opportunity to record his or her \nthoughts and feelings as they occur, rather than having to remember all of the details of \na complex event later.\nBehavioral Assessment\n A behavioral assessment involves directly observing a person\u2019s behavior or asking", "source": "shyness_social.pdf"}
{"id": "b80ae84be335-1", "page_content": "Behavioral Assessment\n A behavioral assessment involves directly observing a person\u2019s behavior or asking \nthe person to perform a speci\ufb01c behavior and then measuring the thoughts and feelings \nthat arise in that situation. The most common types of behavioral assessment for social", "source": "shyness_social.pdf"}
{"id": "9b67c694857e-0", "page_content": "Getting to Know Your Social Anxiety\n43anxiety are the behavioral approach test  and behavioral role-play . These involve having a person \nenter a feared social situation (behavioral approach test) or act out a feared situation \nin a role-play (behavioral role-play) and having the person report his or her fear level, \nanxious thoughts, and other experiences.\nAlthough these assessments are usually conducted by a psychologist, psychia -\ntrist, or other professional, each can be adapted to be part of your self-assessment. We \n recommend that your assessment include the following three steps:\nU\u00caConduct a self-interview. For example, answer important questions about \nyour anxiety and related problems.\nU\u00caComplete anxiety diaries. An example is the Three Components of Social \nAnxiety Monitoring Form included in chapter 1.\nU\u00caComplete a behavioral approach test or role-play.\nConducting a Self-Interview\nAny professional contact with a psychologist, psychiatrist, or other mental health \nprofessional typically begins with a clinical interview, during which the clinician asks the \nclient or patient questions about his or her problems. The interview helps the clinician to \nidentify the most important features of the problem and is a \ufb01rst step toward developing \nan effective treatment plan. To be consistent with this goal, we suggest that you conduct \na self-interview , in which you answer important questions about your problem.\nTo help you with this process, we have identi\ufb01ed ten basic questions you should try \nto answer at the start of your self-assessment. The answers to these questions will help \nyou to do the following: decide whether social anxiety is in fact a problem for you; iden -\ntify the factors that contribute to your social anxiety; and choose the speci\ufb01c situations", "source": "shyness_social.pdf"}
{"id": "9b67c694857e-1", "page_content": "that you need to work on most. At the beginning of chapter 4, we will suggest additional \nquestions that will help you to develop a treatment plan.\nWHICH SOCIAL SITUATIONS DO YOU FEAR AND AVOID?\nFor each of the following situations (divided into interpersonal situations and per -\nformance situations, as de\ufb01ned in chapter 1), record a number ranging from 0 to 100 to \nrate (1) the extent to which you fear the situation during a typical or average encounter \nand (2) the extent to which you typically avoid the situation. For example, if you have an \nintense fear of making presentations but you avoid the situation only about half the time, \nyour fear rating might be an 80 and your avoidance rating might be a 50. If the situation \nis one that you never encounter, base your ratings on how fearful you imagine  you would \nbe in the situation and how much you would avoid the situation if it did come up from \ntime to time. Use the following scales to rate your fear and avoidance levels.", "source": "shyness_social.pdf"}
{"id": "2007d9a644e4-0", "page_content": "The Shyness & Social Anxiety Workbook\n44Fear Scale\n0 10 20 30 40 50 60 70 80 90 100\nNone Mild Moderate Extreme Very \nExtreme\nAvoidance Scale\n0 10 20 30 40 50 60 70 80 90 100\nNever  \nAvoidRarely  \nAvoidSometimes  \nAvoidOften  \nAvoidAlways  \nAvoid\nFeared Social Situations Worksheet\nInterpersonal Situations (interacting with others)\nFear Avoidance Item\n  Asking someone out on a date\n  Starting a conversation with a classmate or coworker\n  Going to a party\n  Having friends over for dinner\n  Being introduced to new people\n  Talking on the telephone with a friend\n  Talking on the telephone with a stranger\n  Expressing a personal opinion (for instance, expressing \nyour views about a movie that you saw recently or a book \nthat you\u2019ve read)\n  Being interviewed for a job\n  Being assertive (such as refusing an unreasonable request)\n  Returning an item to a store \n  Sending back food in a restaurant\n  Making eye contact\n  Other (specify)                  \n  Other (specify)                  \n  Other (specify)", "source": "shyness_social.pdf"}
{"id": "e77521cbbdc7-0", "page_content": "Getting to Know Your Social Anxiety\n45Performance Situations (being observed by others)\nFear Avoidance Item\n  Giving a presentation at work\n  Making a toast at a party or family gathering\n  Speaking in meetings at work or school\n  Playing sports or participating in aerobics in front of \nothers\n  Standing in a wedding party at someone else\u2019s wedding\n  Singing or performing music in front of others\n  Eating or drinking in front of others\n  Using public bathrooms with others in the room\n  Writing with others watching (such as signing a check)\n  Making a mistake in public (for instance, mispronouncing a \nword)\n  Walking or jogging in a busy public place\n  Introducing yourself in front of a group\n  Shopping in a busy store\n  Other (specify)                  \n  Other (specify)                  \n  Other (specify)                  \nWHICH VARIABLES MAKE YOUR ANXIETY BETTER OR WORSE?\nAn important step in your self-assessment is to become aware of the variables that \nmake your fear better or worse in a given situation. For example, if you are fearful \nof eating with other people, there are many factors that could in\ufb02uence your fear in \nthis situation, including who you\u2019re eating with, where you\u2019re eating, and what you\u2019re \neating. Identifying the variables that affect your level of fear in a particular situation \nwill help you to set up appropriate practices when you begin to use the exposure-based \n techniques discussed later in this book.\nFollowing is a list of variables that sometimes affect a person\u2019s fear and anxiety \nin social situations. For each item, record a number ranging from 0 to 100 to rate the \nextent to which the variable listed affects your level of fear or discomfort in the types of", "source": "shyness_social.pdf"}
{"id": "e77521cbbdc7-1", "page_content": "extent to which the variable listed affects your level of fear or discomfort in the types of \nsocial situations that you fear. For example, if you are much more anxious when talking \nto a woman than when talking to a man, you might rate the effect of the other person\u2019s \nsex on your anxiety at about a 75 or 80. Use the following scale to obtain your rating.", "source": "shyness_social.pdf"}
{"id": "8ae34523abdd-0", "page_content": "The Shyness & Social Anxiety Workbook\n46Effect on Your Discomfort Scale\n0 10 20 30 40 50 60 70 80 90 100\nNo \nEffectSmall  \nEffectModerate  \nEffectLarge  \nEffectVery  \nLarge  \nEffect\nYour Anxiety Variables\nAspects of the Other Person and their Effect on Your Discomfort\nEffect \non Your \nDiscomfortItem\n Age (whether the other person is older, younger, or the same age as \nyou)\n Sex of the other person (same sex, opposite sex)\n Relationship status of the other person (married, dating someone, \nsingle)\n Physical attractiveness of the other person\n Nationality or ethnic background of the other person\n How con\ufb01dent the other person seems\n How aggressive or pushy the other person seems\n How interesting the other person appears to be\n Whether the person appears to have a good sense of humor\n How \ufb01nancially successful the other person seems to be\n How well dressed the other person appears to be\n Other (specify)                  \n Other (specify)", "source": "shyness_social.pdf"}
{"id": "91674073dff1-0", "page_content": "Getting to Know Your Social Anxiety\n47My Relationship with the Other Person and Its Effect on Your Discomfort\nEffect \non Your \nDiscomfortItem\n How well you know the other person (family member, close friend, \nacquaintance, stranger, and so on)\n How intimate and close you are to the other person\n Whether there is a history of con\ufb02ict between yourself and the other \nperson\n The type of relationship between you and the other person (for \nexample, supervisor, coworker, employee)\n Other (specify)                  \n Other (specify)                  \nAspects of How You Are Feeling and Its Effect on Your Discomfort\nEffect \non Your \nDiscomfortItem\n How tired you are overall\n General level of stress in your life at the time\n How familiar you are with the topic being discussed\n How prepared you are before entering the situation (for example, \nwhether you have had a chance to rehearse your presentation)\n Other (specify)                  \n Other (specify)", "source": "shyness_social.pdf"}
{"id": "a320a6bcf0a3-0", "page_content": "The Shyness & Social Anxiety Workbook\n48Aspects of the Situation and Their Effect on Your Discomfort\nEffect \non Your \nDiscomfortItem\n Lighting (for instance, the light level is so high that you feel that any \nsign of anxiety will be visible)\n How formal the situation is (for example, eating at a wedding reception \nvs. a casual dinner with friends)\n Number of people involved (such as presenting to a few coworkers vs. \npresenting to a \ufb01lled auditorium)\n Activity involved (eating, speaking, writing, and so on)\n Your physical position (seated, standing, and so on)\n Whether you can use alcohol or drugs to feel more comfortable\n How long you\u2019re stuck in the situation for\n Other (specify)                  \n Other (specify)                  \nWHAT ARE YOUR FEELINGS AND HOW DO YOU FEEL  \nABOUT THEM?\nFollowing is a list of physical feelings that people sometimes experience when they \nare feeling anxious, worried, or frightened. For each item, you should \ufb01rst record a \nnumber (from 0 to 100) that re\ufb02ects the intensity of the feeling during a typical expo -\nsure to an anxiety-provoking social situation. A rating of 0 means that, typically, you do \nnot experience the sensation at all, and a rating of 100 means that the sensation typically \nis extremely intense when you encounter social situations that are a problem for you.\nNext, using a scale from 0 to 100, rate the extent to which you are fearful of experi -\nencing the sensation in front of other people. A rating of 0 means that you are not at all \nconcerned about experiencing the sensation in front of others and a rating of 100 means \nthat you are extremely fearful of experiencing the sensation in front of others.", "source": "shyness_social.pdf"}
{"id": "a320a6bcf0a3-1", "page_content": "that you are extremely fearful of experiencing the sensation in front of others.\nIntensity of the Physical Sensations Scale\n0 10 20 30 40 50 60 70 80 90 100\nNot \nat AllMild Moderate Extreme Very \nExtreme", "source": "shyness_social.pdf"}
{"id": "1c9a17e9fa1f-0", "page_content": "Getting to Know Your Social Anxiety\n49Fear of Having the Physical Sensations in Front of Others Scale\n0 10 20 30 40 50 60 70 80 90 100\nNo \nFearMild  \nFearModerate  \nFearExtreme  \nFearVery \nExtreme  \nFear\nIntensity of \nSensationYour \nFear of \nSensationSensation\n  Racing or pounding heart\n  Breathlessness or smothering feelings\n  Dizziness or lightheadedness\n  Dif\ufb01culty swallowing, choking feelings, or a \u201clump\u201d in the \nthroat\n  Quivering or shakiness (in the hands, knees, lips, or \nwhole body)\n  Blushing\n  Nausea, diarrhea, or \u201cbutter\ufb02ies\u201d in the stomach\n  Excessive sweating\n  Shaky voice\n  Tearfulness, crying\n  Poor concentration (forgetting what you\u2019re trying to say)\n  Blurred vision\n  Numbness and tingling sensations\n  Feelings of unreality or being detached from your body \nor from things around you\n  Tightness, soreness, or weakness in the muscles\n  Chest pain or tightness in chest muscles\n  Dry mouth\n  Hot \ufb02ushes or chills\n  Other (specify)                 \n  Other (specify)", "source": "shyness_social.pdf"}
{"id": "b5d02ed5bf6d-0", "page_content": "The Shyness & Social Anxiety Workbook\n50 WHAT ARE YOUR ANXIETY-PROVOKING BELIEFS, PREDICTIONS, \nAND EXPECTATIONS?\nAs discussed in chapter 1, your beliefs have a big impact on how you feel in social \nsituations. For example, if you expect that others will think you are stupid, weak, or \nunattractive, you are very likely to feel anxious around other people. On the other hand, \nif you are not especially concerned about what others think about you in a particular \nsituation, you\u2019re much more likely to feel comfortable. Often, our beliefs and predic -\ntions are not based on reality. For people who experience elevated anxiety in social and \nperformance situations, beliefs and expectations about these situations are often nega -\ntive. These thoughts tend to exaggerate the likelihood of danger and lead the person to \nexpect the worst, even when there is no reason to do so.\nCognitive therapy involves teaching people to identify and change their anxious \nbeliefs, predictions, and expectations by considering more realistic alternative beliefs. \nBefore you can change your thoughts, however, you need to be able to observe them \nand to decide whether they are unrealistic and whether they are contributing to your \nanxiety.\nChapter 1 lists examples of thoughts and expectations that contribute to social \nanxiety. Some of these include basic assumptions, such as, \u201cIt is important that every -\none likes me\u201d and \u201cNobody will ever think I am interesting.\u201d Other anxiety-provoking \nthoughts may be more focused on a particular situation, such as, \u201cIf I arrive at class early, \nI won\u2019t be able to think of anything to say\u201d and \u201cPeople will think I am weird if they \nnotice my hands shaking.\u201d", "source": "shyness_social.pdf"}
{"id": "b5d02ed5bf6d-1", "page_content": "notice my hands shaking.\u201d\nTo identify your own anxiety-provoking thoughts, we recommend the following \nsteps. First, review some of the examples of anxiety-provoking thoughts listed in chapter \n1. These will give you an idea of the types of thoughts that are often associated with \nsocial anxiety. Next, think of social situations that you \ufb01nd particularly dif\ufb01cult (for \nexample, talking to strangers, eating with other people, speaking at meetings) and try to \nanswer the following questions. Your answers to these questions will give you an idea of \nthe types of thoughts, predictions, and expectations that help to maintain your anxiety.", "source": "shyness_social.pdf"}
{"id": "f4f60f9793bc-0", "page_content": "Getting to Know Your Social Anxiety\n51Your Anxiety-Provoking Beliefs\nWhat am I afraid will happen in the situation?\nWhat might people think about me in the situation?\nIs it almost always important that I make a good impression? Why?\nHow will I react in the situation (what symptoms will I exhibit)?\nWhat if my expectations come true? What might that lead to?\nAm I aware of any other beliefs or predictions that contribute to my anxiety?", "source": "shyness_social.pdf"}
{"id": "577fde92a8ad-0", "page_content": "The Shyness & Social Anxiety Workbook\n52WHAT ARE YOUR ANXIOUS BEHAVIORS?\nAnxiety and fear are usually accompanied by a strong urge to do something to \nreduce these uncomfortable feelings. Are there behaviors that you use to reduce your \nanxiety? Here are some examples.\nAvoidance of social situations.  Are there situations that you refuse to enter? For example, \ndo you avoid going to parties, particularly when you won\u2019t know people there? When \nthe telephone rings, do you avoid answering it? Do you turn down opportunities to do \npresentations even when they are important? Avoidance is one of the most common \nbehaviors that helps to maintain your fear and anxiety. Earlier in this chapter you rated \nthe extent to which you fear and avoid various social situations. As part of this review \nof your anxious behaviors, look over that list again and note which situations you tend \nto avoid at least some of the time. If there are any other situations that come to mind, \nlist them below.\nOvercompensating for perceived de\ufb01cits.  Are there ways in which you try extra hard \nin social situations to compensate for \ufb02aws or faults that you perceive yourself to have? \nFor example, do you overprepare for presentations by putting together too much mate -\nrial, memorizing the presentation, or reading the presentation word for word from your \nnotes? Do you rehearse everything that you are going to say before meeting a friend \nfor dinner, just in case you become overly anxious and lose your train of thought? Do \nyou go out of your way to talk a lot to appear outgoing, just so people won\u2019t notice that \nyou\u2019re anxious? Each of these is an example of how people sometimes overcompensate", "source": "shyness_social.pdf"}
{"id": "577fde92a8ad-1", "page_content": "you\u2019re anxious? Each of these is an example of how people sometimes overcompensate \nto cover up what they perceive to be \ufb02aws. If you can think of examples of times when \nyou have overcompensated in social situations for what you thought were \ufb02aws or faults, \nlist them below.\nExcessive checking and reassurance seeking.  Social anxiety, shyness, and performance \nanxiety sometimes can lead people to engage in frequent checking and reassurance \nseeking behaviors. Examples include frequently looking in the mirror to make sure that", "source": "shyness_social.pdf"}
{"id": "6be1ba85d55e-0", "page_content": "Getting to Know Your Social Anxiety\n53your hair is perfect and continually asking your friends to reassure you that you are \ninteresting or smart.\nAlthough it is helpful to seek reassurance from time to time, constant reassurance \nseeking can have a negative impact by helping to maintain your fear. By asking for reas -\nsurance over and over again, you may strengthen the belief that there is something \nwrong with you. (Why else would you need to check so often?). Also, you run the risk \nof never learning to provide yourself with the reassurance that you may need. Finally, \nconstantly asking others for reassurance may cause some of your greatest fears to come \ntrue by negatively affecting how others view you. Other people may get tired of always \nhaving to provide you with reassurance. Also, if you constantly ask others to make judg -\nments about you (for instance, to tell you how smart, attractive, or interesting you are), \nyou may actually be training them to be more observant and scrutinizing of you than \nthey might otherwise be.\nIn the space below, list some examples of times when you have engaged in excessive \nchecking or reassurance seeking.\nOther subtle avoidance and safety behaviors.  Overcompensating for perceived de\ufb01cits \nand excessive checking are both examples of safety behaviors  because they are used to \nhelp you feel safer in social situations. Unlike complete avoidance of feared situations, \nthese are more subtle avoidance behaviors, and they can be more dif\ufb01cult to notice. Are \nthere other subtle ways in which you avoid situations or safety behaviors that you use to \nprotect yourself from feeling anxious in social situations?\nFor example, if you have to give a presentation, do you stand in a particular place?", "source": "shyness_social.pdf"}
{"id": "6be1ba85d55e-1", "page_content": "Do you wear certain clothes to hide \u201cdefects\u201d that you perceive in your appearance? Do \nyou purposely end the presentation late so that there is no time for questions? Do you \nuse videos or slides during the presentation so the focus won\u2019t be on you? Do you avoid \nmaking eye contact with the audience? If you\u2019re attending a party, do you purposely stay \nclose to someone you know well so that you won\u2019t have to talk to other people? Do you \nhave a drink or two as soon as you get to the party so that your anxiety doesn\u2019t get too \nhigh? Do you offer to help in the kitchen so you won\u2019t have to talk to the other guests? \nDo you take frequent bathroom breaks to avoid being with everyone else? When you\u2019re \ntalking to other guests at the party, do you ask the other person lots of questions to keep \nthe focus of the conversation off of you?\nAll of these are examples of subtle avoidance strategies that people sometimes use in \nsocial situations. As discussed in chapter 1, these behaviors may decrease your anxiety \nin the short term by helping you to feel safer. However, in the long term, they typically \nhave the effect of preventing your anxiety from decreasing naturally over time because", "source": "shyness_social.pdf"}
{"id": "431737d8b32d-0", "page_content": "The Shyness & Social Anxiety Workbook\n54they prevent you from learning that the situation can be safe and manageable even \nwithout relying on subtle avoidance strategies. In the spaces that follow, list examples of \nsubtle avoidance or safety behaviors that you use to manage your anxiety in social situ -\nations. Because these behaviors may differ from situation to situation, there is space to \nrecord these behaviors for up to \ufb01ve different social situations.\nSocial Situation     Subtle Avoidance and Safety Behaviors\n            \n            \n            \n            \n            \n            \n            \n            \n            \n            \nComparing yourself to the \u201cwrong\u201d people.  One of the ways in which we evaluate our -\nselves is to make comparisons with other people. In school, we ask our classmates how \nthey did on their exams to get an idea of how our own work compares to that of others. \nWe are curious about our coworkers\u2019 salaries, in part because having that  information is \na way of knowing whether we are being paid fairly.\nResearch has consistently found that most people compare themselves to others \nwhom they perceive to be either similar to themselves or slightly better in a particular \ndimension. For example, an average student is likely to compare his or her grades to \nthose of other average students or to slightly better-than-average students. Similarly, a \ntop athlete tends to compare his or her performance to other top athletes in order to \njudge the quality of his or her own performance. This pattern of social comparison makes \nsense because it is most likely to provide information you can use to gauge your own \nperformance. Comparing yourself to someone whom you perceive to be much better or \nmuch worse than you in a particular dimension will provide information that isn\u2019t espe -\ncially relevant to you. For example, if you are a musician who plays mostly in local clubs,", "source": "shyness_social.pdf"}
{"id": "431737d8b32d-1", "page_content": "it doesn\u2019t make sense to compare your success to that of the most popular and successful \nmusicians in the world. Making such comparisons is likely to cause you to feel inadequate \nbecause you will perceive that you can\u2019t possibly compete with the best.", "source": "shyness_social.pdf"}
{"id": "5f324109e5d1-0", "page_content": "Getting to Know Your Social Anxiety\n55Research from our center (Antony et al. 2005) suggests that people who are \nsocially anxious make different types of social comparisons than do those who are less \nanxious. Speci\ufb01cally, social anxiety is associated with a tendency to make more frequent \n\u201cupward\u201d comparisons. In other words, people who are socially anxious are more likely \nto compare themselves to people they perceive as better than they are. The tendency \nto make upward comparisons increases the likelihood that an individual will feel worse \nafter making the comparison.\nCan you think of recent examples of when you have compared yourself to someone \nwhom you perceived to be more attractive, more competent, less anxious, stronger, or \nsmarter than you are? Or, did you make an upward comparison on some other dimension? \nHow did you feel afterward? Do you often tend to compare yourself to people whom \nyou perceive to be ideal or perfect on a certain dimension, rather than people whom you \nperceive to be typical or average? In the space below, describe an example of a time when \nyou compared yourself to someone who was much \u201cbetter\u201d than you in some way.\nCOULD YOU BENEFIT FROM IMPROVING YOUR \u201cPEOPLE SKILLS\u201d?\nEveryone has times when they give off the wrong impression simply because they \ndidn\u2019t know how to communicate a particular message to another person or group. \nGenerally, this is not a big problem unless it happens frequently or in situations where \nthere is a lot at stake.\nIn most cases, people who are socially anxious have \ufb01ne social skills, though they tend \nto assume that their social skills are much worse than they actually are. Furthermore, as \ntheir anxiety decreases and they obtain more practice interacting with others in the situ -", "source": "shyness_social.pdf"}
{"id": "5f324109e5d1-1", "page_content": "their anxiety decreases and they obtain more practice interacting with others in the situ -\nations that they fear, their skills tend to improve over time. Following are some examples \nof areas where you may want to consider working on improving your skills. This may \nprove to be particularly helpful for situations that you have tended to avoid over the \nyears and therefore may not have had the opportunity to learn some of the subtleties \nof navigating your way through the situation. For example, if you have never dated, you \nmay need some practice before knowing how to ask someone out on a date to maximize \nyour chances of a positive response. As you read through the examples, try to identify \npeople skills that you may want to work on. There is space at the end of this section to \nrecord your responses.\nAssertiveness.  Do you have dif\ufb01culty being assertive? In other words, is it hard for you \nto say no if someone asks you to do something that you don\u2019t want to do? Is it  dif\ufb01cult \nto ask people to change their behavior if they are treating you unfairly or aren\u2019t doing", "source": "shyness_social.pdf"}
{"id": "caf70013e07e-0", "page_content": "The Shyness & Social Anxiety Workbook\n56their share of the work? Most people sometimes \ufb01nd it dif\ufb01cult to deal directly and \nassertively with situations like these. However, the more dif\ufb01culty that you have in situ -\nations that call for assertive communication, the more you have to gain from learning \nassertiveness skills.\nBody language, tone of voice, and eye contact.  Do you have dif\ufb01culty making eye contact \nwith other people? Does your tone of voice or body language send the message that you \nare not open to interacting with others? Behaviors that convey such messages may include \nspeaking very quietly or letting your voice drop off at the end of your sentences, standing \nfar away from other people when you\u2019re talking with them, answering questions with very \nshort responses, and displaying a \u201cclosed\u201d body posture (such as crossing your arms and \nlegs). Although you may use these behaviors to protect yourself in social situations, they \nmay actually have the opposite effect by turning others away. If you send the message to \nothers that you are unavailable, they will be more likely to leave you alone.\nConversation skills.  Do you have dif\ufb01culty knowing what to say when talking to people \nat work or school? Is it hard to know how or when to end conversations? Do you \ufb01nd \nit dif\ufb01cult to know where the \ufb01ne line is between appropriate self-disclosure and talking \ntoo much about yourself? Do you often offend other people with comments that you \nmake? If you have dif\ufb01culty making small talk or engaging in casual conversations, you \nmay bene\ufb01t by working on improving these skills.\nMeeting new people.  Do you have dif\ufb01culty knowing what to say when you want to", "source": "shyness_social.pdf"}
{"id": "caf70013e07e-1", "page_content": "initiate contact with new people? Do you have dif\ufb01culty asking someone out on a date? \nAre you at a loss for knowing how and where to meet new people? There are lots of \ndifferent places to meet new people and lots of tricks to making meeting people easier. \nThe \ufb01rst step is identifying whether this is an area that you would like to work on.\nPresentation skills.  Speaking effectively in public involves a number of complex skills \nand behaviors. It\u2019s not enough to be calm and con\ufb01dent. An effective speaker also knows \nhow to maintain the audience\u2019s interest by using humor and effective audiovisual aids \nand handouts, stimulating audience participation, and conveying an interest in the topic. \nIf you fear making presentations, part of overcoming your fear may include improving \nyour speaking skills.\nIn the space below, list any social or communication skills that you might like to \nimprove.\nSocial Skills That I Would Like to Develop or Improve", "source": "shyness_social.pdf"}
{"id": "f6a3039b46c8-0", "page_content": "Getting to Know Your Social Anxiety\n57HOW MUCH DOES YOUR SOCIAL ANXIETY BOTHER YOU OR \nINTERFERE WITH YOUR LIFE?\nAs we discussed in chapter 1, social anxiety, shyness, and performance-related fears \nare only a problem if they interfere with aspects of your functioning or if having the \nfear is troublesome for you. So, as part of your self-assessment, it\u2019s important for you to \ndetermine which aspects of your fear trouble you and which don\u2019t. Are there particular \nsituations for which you are most interested in overcoming your fear? For example, it \nmay be important for you to overcome your fear of socializing with friends but relatively \nless important for you to overcome your fear of speaking in front of large groups if that \nsituation never arises.\nIn the space below, record (1) the ways in which your social anxiety interferes with \nyour functioning (including work or school, social life, relationships, hobbies and leisure \nactivities, home and family life), (2) the speci\ufb01c aspects of your social anxiety that \nyou most want to change, and (3) any aspects of your social anxiety that you are not \n interested in working on.\nWays in Which Social Anxiety Interferes with My Life\nAspects of My Social Anxiety That I Want to Change\nAspects of My Social Anxiety That I Don\u2019t Want to Change", "source": "shyness_social.pdf"}
{"id": "3b43af2dbb9c-0", "page_content": "The Shyness & Social Anxiety Workbook\n58 HOW AND WHEN DID YOUR SOCIAL ANXIETY BEGIN?\nHow old were you when you \ufb01rst had signi\ufb01cant anxiety in social situations? What was \ngoing on at that time in your life?\nHow old were you when you \ufb01rst noticed that your social anxiety began to interfere with \naspects of your life? What was going on at the time?\nWhat has the course of your social anxiety been over the years? Has it improved, stayed \nthe same, or worsened? Are you aware of factors that may have caused it to change over \nthe years (for example, getting married or moving to a new neighborhood)?\nAre there speci\ufb01c events that initially caused you to become more nervous in social \nsituations or made your social anxiety worsen? (Examples may include experiences such \nas presentations that didn\u2019t go well, being teased while growing up, or doing something \nembarrassing or humiliating in public.)", "source": "shyness_social.pdf"}
{"id": "d2dbb5fa3323-0", "page_content": "Getting to Know Your Social Anxiety\n59DOES ANYONE ELSE IN YOUR FAMILY HAVE THIS PROBLEM?\nAre you aware of anyone else in your family having problems with shyness, social anxiety, \nor performance-related fears? If so, do you think that this had an in\ufb02uence on how you \nfeel in these situations? If yes, how?\nARE THERE ANY PHYSICAL CONDITIONS THAT CONTRIBUTE TO \nYOUR SOCIAL ANXIETY?\nFor some individuals, certain physical or medical conditions may in\ufb02uence their \ntendency to experience social anxiety. For example, people who stutter may be more \nnervous when talking to others compared with people who don\u2019t stutter. Often, their \nfear is exclusively related to a concern that they will stutter and that others will notice. \nSimilarly, people suffering from other medical conditions (for example, shaking due \nto Parkinson\u2019s disease, having to move about in a wheelchair, not being able to write \nneatly due to severe arthritis) may be self-conscious about having others observe their \nsymptoms.\nOther people, although they may not be suffering from a medical condition, may \nstill have a greater tendency than others to have shaky hands, blush easily, or sweat \nexcessively, independent of their fears. For these individuals, these reactions tend to be \nvery intense and may often occur even outside of social situations and when they are not \nparticularly anxious. Although many people who experience these symptoms at such an \nextreme level are not concerned about others noticing, for some, having these extreme \nsymptoms contributes to their social anxiety.\nDo you suffer from any physical conditions or medical illnesses that add to your anxiety \naround other people? If so, record the details below.\nDIARIES", "source": "shyness_social.pdf"}
{"id": "d2dbb5fa3323-1", "page_content": "around other people? If so, record the details below.\nDIARIES\nThe diaries used to assess social anxiety are usually forms on which individuals record \ntheir anxiety-related symptoms, including frequency of exposure to feared situations,", "source": "shyness_social.pdf"}
{"id": "ffeb88577031-0", "page_content": "The Shyness & Social Anxiety Workbook\n60anxiety levels (using a numeric scale such as 0 through 100), uncomfortable physical \nsensations such as blushing or shaking, anxious thoughts and predictions (for instance, \n\u201cI will make a fool of myself during this presentation\u201d), and anxious behaviors such as \navoidance and distraction. An example of such a diary is the Three Components of \nSocial Anxiety Monitoring Form, which you completed in chapter 1. Numerous other \nforms and diaries are included throughout this book as well. They are designed to be \nused while you try the speci\ufb01c treatment techniques described in later chapters.\nBEHAVIORAL ASSESSMENTS\nThe most commonly used type of behavioral assessment for social anxiety is the \nBehavioral Approach Test, or BAT. This assessment method involves physically entering \na feared situation and measuring your anxiety and associated symptoms. For example, if \nyou are afraid of public speaking, you might force yourself to speak at a staff meeting. \nAfter the meeting, you can record the particulars of the situation (who else was there, \nhow long you spoke for, and so on), your fear level (for example, 80 out of 100), your \nanxious thoughts (such as, \u201cMy words will come out all jumbled\u201d), and whether you \nengaged in any avoidance behaviors (like avoiding eye contact).\nIf it is too frightening to try this in a real-life situation, or if it is impossible to do \nso for another reason, the assessment can be completed in the form of a role-play. In \na role-play, the person acts out the feared situation with the therapist or another indi -\nvidual present, instead of being in the real situation. For example, if you are afraid of", "source": "shyness_social.pdf"}
{"id": "ffeb88577031-1", "page_content": "job interviews, you might try to practice a job interview with another person (friend, \nfamily member, or therapist) taking the role of the interviewer. Following the practice, \nyou would again record the particulars of the situation, your fear level, your anxious \nthoughts, and your avoidance behaviors.\nTherapists use behavioral assessments because they have several advantages over \ntraditional forms of assessment, such as interviews and questionnaires. First, they are \nless likely to be in\ufb02uenced by people\u2019s dif\ufb01culties in remembering the details of their \nfears. For example, some people may overestimate or underestimate their fear levels if \nthey are asked to describe their fear during past exposures to feared situations. Their \nmemories may be in\ufb02uenced by a particularly negative experience in a feared situation \nand, as a result, they may report that their fear is actually higher than it typically is. \nAlso, people\u2019s memories regarding their reactions in the situations they fear may be poor \nsimply because they typically avoid the fearful situation, making it dif\ufb01cult to know for \nsure how they feel when they are exposed to the situation.\nAnother advantage of the behavioral approach test is that it allows the therapist and \nthe individual to directly observe anxious thoughts and behaviors that might otherwise \ngo unnoticed. It also allows the therapist to independently assess the extent to which the \nclient\u2019s shaking, blushing, or sweating is actually noticeable to others.", "source": "shyness_social.pdf"}
{"id": "accb51b838f4-0", "page_content": "Getting to Know Your Social Anxiety\n61Can you think of a behavioral approach test or role-play that you can set up for \nyourself? For example, if you are fearful of speaking up in a meeting, try doing it anyway. \nImmediately after the meeting, record your physical symptoms, anxious thoughts, and \nthe avoidance behaviors that took place while you were conducting the practice. Did it \ngo better than you expected it to go? Was it worse? Was it about what you expected?\nTROUBLESHOOTING\nYou may \ufb01nd that your self-assessment does not go as smoothly as you might like. Here \nare some common problems that may arise during your self-assessment, as well as some \nsolutions, suggestions, and words of reassurance.\nProblem:  I didn\u2019t know the answers to all the questions.\nSolution:   That\u2019s to be expected. As you progress with the treatment, you will have \nan opportunity to become better acquainted with your social anxiety. \nSelf-assessment is an ongoing process, and it\u2019s not necessary to have all \nthe answers before you start to work on changing your social anxiety. In \nfact, there may be some questions that you will never know the answers \nto, and that\u2019s okay. The purpose of this chapter is just to help you better \nunderstand the areas that are causing you the most dif\ufb01culty.\nProblem:  Answering these questions increased my anxiety.\nSolution:   This is quite common. Conducting a self-assessment forces you to pay \nattention to the thoughts that contribute to your anxiety. This effect of \nincreased anxiety tends to be temporary. As you progress through the \ntreatment procedures discussed throughout this book, it is likely you \nwill \ufb01nd that focusing on the thoughts and feelings associated with your", "source": "shyness_social.pdf"}
{"id": "accb51b838f4-1", "page_content": "will \ufb01nd that focusing on the thoughts and feelings associated with your \nsocial anxiety will become less anxiety provoking.\nProblem:   My answers to these questions depend on many different variables, so I \n\ufb01nd it dif\ufb01cult to come up with a response to certain questions.\nSolution:   This concern is often raised by people who are undergoing an assessment. \nQuestions are often dif\ufb01cult to answer because the responses depend \non so many different factors. For example, the question, \u201cHow fearful \nare you of public speaking?\u201d may depend on such things as the topic \nof the presentation, the number of people in the audience, the lighting \nin the room, the length of the presentation, how prepared you are, and \nmany other factors. We suggest that you handle dif\ufb01cult  questions by \nestimating your response based on a typical or average situation. So, \nif your fear of public speaking ranges from 30 to 70 depending on the \nsituation, you could put down 50. If you prefer, you could just record \nthe range \u201c30 to 70\u201d which would be more precise.", "source": "shyness_social.pdf"}
{"id": "a8a1702e2e2b-0", "page_content": "The Shyness & Social Anxiety Workbook\n62After reading this chapter, you should have a better understanding of the nature of \nyour social anxiety. You should be more aware of the types of social situations that you \nfear and avoid, the variables that affect your discomfort level, the physical sensations \nthat you experience when you are anxious, the thoughts and behaviors that contribute to \nyour fear, and the ways in which social anxiety interferes with your life. Understanding \nthese aspects of your social anxiety will help you to choose the best strategies for over -\ncoming your fear as you work your way through the rest of this book.", "source": "shyness_social.pdf"}
{"id": "2ad940b4c39d-0", "page_content": "PART 2\nHow to Overcome Social \nAnxiety and Enjoy Your Life", "source": "shyness_social.pdf"}
{"id": "37465d7fe6f3-0", "page_content": "CHAPTER 4\nMaking a Plan for Change\nThis chapter will help you to consider the range of factors that are important for devel -\noping a treatment plan. These factors include deciding whether this is the best time for \nyou to work on your social anxiety, addressing the issue of motivation and readiness for \nchange, selecting treatment goals, trying to understand why treatment may or may not \nhave worked in the past, and understanding your current options for treatment.\nIS NOW THE BEST TIME TO START  \nTHIS PROGRAM?\nIn some ways, it may seem as if there is never a good time to begin a new project. \nThere are almost always competing demands that make it dif\ufb01cult to \ufb01nd free time or \nextra energy to start something new. Work may be unusually busy, you may be getting \nover a cold, or your children may be a handful right now. Although the time may not \nbe perfect, you will need to decide whether it is even a possibility for you to start this \nprogram given your current life circumstances. Your chances of getting the most out of \nthis book will depend on your answering yes to the following questions:\nU\u00caAre you motivated to become less shy or to decrease your social anxiety? \nIs this something you really care about?\nU\u00caAre you willing to feel even more anxious in the short term in order to feel \nmore comfortable in social and performance situations in the future?", "source": "shyness_social.pdf"}
{"id": "ada66023ed9c-0", "page_content": "The Shyness & Social Anxiety Workbook\n66U\u00caAre you able to put aside, at least to some extent, other major problems and \nstresses in your life (things such as family problems or work stresses) so that \nyou can focus on learning to manage your social and performance anxiety?\nU\u00caAre you able to set aside several blocks of time several days per week to \npractice the techniques described in this book?\nHopefully, after carefully considering these questions, you will make a commitment \nto work on overcoming your social anxiety. However, you may also decide that this \nis not the best time for you to work on the problem and that you would rather wait \nuntil your life situation changes. If that is the case, you may still \ufb01nd reading this book \nhelpful because it contains strategies that can be used from time to time, as you need \nthem. However, making big changes will require using the techniques described in this \nbook frequently and consistently. The next section will help you further as you decide \nwhether to work on your anxiety at this time.\nMOTIVATION AND READINESS FOR CHANGE\nExperts have identi\ufb01ed \ufb01ve stages that people go through as they contemplate making \na change in behavior, such as quitting smoking, losing weight, or improving their work \nhabits (Prochaska, DiClemente, and Norcross 1992). The model describing these stages of \nchange  is often referred to as the transtheoretical model of change. These \ufb01ve stages include:\n1. Precontemplation . At this stage, people are unaware that they have a problem \nor they have no intention of changing, either because they are unwilling to \nchange or they are convinced that change is impossible. An example would", "source": "shyness_social.pdf"}
{"id": "ada66023ed9c-1", "page_content": "change or they are convinced that change is impossible. An example would \nbe someone who is very overweight and is convinced that nothing can be \ndone about it. (So why bother trying?)\n2. Contemplation . At this stage, the individual intends to change sometime \nsoon (for example, in the next six months). The person is aware of the ben -\ne\ufb01ts of changing but is also still focused on the possible costs. An example \nis a smoker who\u2019s thinking about quitting in a few months.\n3. Preparation . At this stage, the person is ready to change in the near future \n(for example, in the next month). The bene\ufb01ts of change are much more \nobvious to the person than the costs of changing. An example is someone \nwho has decided to join a gym in a couple of weeks to become more \ufb01t.\n4. Action . At this stage, the individual actually takes steps to change a problem \nbehavior. For example, an individual who feels depressed might start to see \na therapist for depression.", "source": "shyness_social.pdf"}
{"id": "c9ab5fce22c1-0", "page_content": "Making a Plan for Change\n675. Maintenance . At this stage, the individual has made the change and is taking \nsteps to prevent the problem behavior from returning. An example would be \nan individual with a history of problem drinking who has now been sober for \nsix months and has stopped spending time with people who drink excessive \namounts of alcohol.\nAlthough this model has been studied mostly in people who are working on chang -\ning health habits (for example, exercise, diet, substance abuse, improving medication \ncompliance), it can also be applied to your treatment for shyness and social anxiety. The \nfurther along you are with respect to these stages of change, the more likely you will \nbe to bene\ufb01t from the strategies described in this book. For example, if you are in the \naction stage, you will likely get more out of this book than if you are at the precontem -\nplation stage and have no intention of making any changes.\nOf course, these stages overlap with one another, and deciding which stage you are \nin is not always so clean cut. In fact, you may be at a different stage for different aspects \nof your social anxiety. You may be convinced that it is completely impossible that you \nwill ever be able to date (precontemplation), but you may be thinking about working on \n\ufb01nding a better job over the next few months (contemplation). You may also have already \nsigned up for a night class so you can start to meet new friends (action). Fortunately, as \nyou make changes in some areas, you may discover that you become more ready to make \nchanges in other areas as well.\nSuccess at changing your social anxiety will require that you are willing, able, and", "source": "shyness_social.pdf"}
{"id": "c9ab5fce22c1-1", "page_content": "Success at changing your social anxiety will require that you are willing, able, and \nready to take action (Miller and Rollnick 2002). Being willing  means that the change is \nimportant to you, and that this is a change you want to make. Being able means that you \nare con\ufb01dent in your ability to make the change (once you have been given the right \ntools and strategies). Being ready  means that this is a high priority for you, and that you \nare prepared to put other priorities aside for now in order to get this done. Use the scale \nbelow to rate the extent to which you are willing, able, and ready to make this change. \nFor each rating, you may use any number from 0 to 100.\n0 10 20 30 40 50 60 70 80 90 100\nNot \nat AllA \nLittleModerately Very  \nMuchCompletely\n    Willing (rate from 0 to 100)\n    Able (rate from 0 to 100)\n    Ready (rate from 0 to 100)", "source": "shyness_social.pdf"}
{"id": "69c80aa34c1c-0", "page_content": "The Shyness & Social Anxiety Workbook\n68COSTS AND BENEFITS OF OVERCOMING  \nYOUR ANXIETY\nFor the majority of people, the bene\ufb01ts of using the strategies described in this book \nwill far outweigh the costs. If you didn\u2019t believe that, you probably wouldn\u2019t be reading \nthis book. Still, you may have mixed feelings about changing, and therefore it may be \nhelpful to think about your reasons for change, as well as your reasons for not changing. \nWe will start with a discussion of the potential costs of change.\nCosts of Overcoming Your Social Anxiety\nIn this section, we discuss the costs of changing. As you go through this section, \nnotice that these potential costs are mostly short-term inconveniences that are only \npresent while you are actively working on your anxiety. As your anxiety improves, these \ncosts will fade as well. Also, instead of thinking about these as costs, it is helpful to think \nof them as challenges . After all, most of these costs are manageable, and there are often \npossible solutions available to minimize their impact.\nCosts of medication treatments.  If you choose to use medications, you will have to \nremember to take them regularly, and newer medications may be expensive, particularly \nif they are not covered by your health plan. You may experience side effects. Depending \non the medication, side effects may include fatigue, headaches, changes in weight and \nappetite, and changes in sexual functioning. Of course, as you will learn in chapter 5, \nmany of the side effects associated with medications are worst in the \ufb01rst few weeks, \nimprove over time, and are generally quite manageable. Side effects can also be mini -\nmized by adjusting doses, changing medications, or stopping medications altogether.", "source": "shyness_social.pdf"}
{"id": "69c80aa34c1c-1", "page_content": "mized by adjusting doses, changing medications, or stopping medications altogether. \nCosts of psychological treatments.  Psychological treatments, such as confronting the \nsituations that you fear, are also associated with costs. First, they are time-consuming. \nTo get the most out of exposure-based treatments, for example, you may need to prac -\ntice for an hour or more, three to \ufb01ve days per week. Also, psychological treatments \ncan be expensive (especially in the short term), depending on your insurance coverage \nand the fees charged by the therapist. In addition, conducting exposure practices will \nprobably make you feel anxious and uncomfortable, particularly at the start. Although \nthe exercises are designed so that the discomfort is usually manageable, at times your \nfear may be intense. In addition to feeling uncomfortable, you may feel more tired, espe -\ncially on days when you practice confronting situations that make you uncomfortable. \nYou also may feel irritable and perhaps even have anxiety-provoking dreams. Finally, \nyour improvement may not follow a smooth course. It is likely the changes will take \ntime and you may have periods (days, weeks, or even months) during which you feel as \nthough you\u2019re slipping backward. For many people this is a normal part of the process", "source": "shyness_social.pdf"}
{"id": "8bb64f625400-0", "page_content": "Making a Plan for Change\n69of overcoming social anxiety. By continuing to use the strategies described in this book, \nhowever, your anxiety should continue to improve over time.\nOther possible costs of improving.  Overcoming your anxiety may also have an impact \non other areas of your life. In most cases, the impact will be positive, but there may be \nsome costs associated with these changes as well. If you are in a long-term relationship, \nyou might \ufb01nd that your partner will need time to adjust to the changes you are making. \nFor example, as you become more comfortable socializing, you may be out more often \nwith friends or coworkers. If your partner is accustomed to having you around most of \nthe time, these changes may require some getting used to. It may be helpful to discuss \nthe changes that you are making openly with your partner, friends, and family members, \nif appropriate. This will demonstrate to them that you are sensitive to how the improve -\nments in your social anxiety may affect them.\nCan you think of other possible costs of overcoming your social anxiety, shyness, or \nperformance-related fears? If so, record them in the following space.\nBene\ufb01ts of Overcoming Your Social Anxiety\nFortunately, there are also bene\ufb01ts of overcoming your social anxiety. As we men -\ntioned in the last section, the costs of overcoming your anxiety are usually just short-\nterm inconveniences. On the other hand, the bene\ufb01ts of change tend to be much more \nlong lasting. What this book challenges you to do is to decide whether you are willing to \ntolerate some short-term pain, to achieve long-term gains. Examples of potential bene\ufb01ts \nof overcoming your shyness and social anxiety include the following:", "source": "shyness_social.pdf"}
{"id": "8bb64f625400-1", "page_content": "of overcoming your shyness and social anxiety include the following:\nU\u00caLearning to feel more comfortable in feared social and performance \nsituations\nU\u00caMeeting new friends\nU\u00caImproving the quality of your relationships\nU\u00caLearning to network more comfortably in situations related to your job or \ncareer\nU\u00caExpanding the possible options for what you can do in your leisure time", "source": "shyness_social.pdf"}
{"id": "54e140729a8e-0", "page_content": "The Shyness & Social Anxiety Workbook\n70U\u00caImproving your job prospects (for instance, realizing new opportunities to \nget a promotion or to seek a higher-paying position)\nU\u00caOpening up some opportunities for self-improvement by furthering your \neducation\nU\u00caLearning to increase your enjoyment of life\nU\u00caFeeling more con\ufb01dent\nU\u00caIncreasing your ability to express yourself\nU\u00caLearning strategies that you may be able to apply to other problems, such \nas anger, depression, or a troubled relationship\nBased on this list of examples, or others that you can identify, can you think of \nbene\ufb01ts that would result from overcoming your social anxiety? Focus on bene\ufb01ts that \nare based on your own internal values and goals (for example, \u201cI want to have closer friend -\nships\u201d), rather than the values and goals of others (for example, \u201cMy mother wants me \nto make new friends\u201d). Questions like the ones listed below can be useful as you identify \nyour own reasons for changing:\nU\u00caHow would I like my life to be different in \ufb01ve years?\nU\u00caWhat would be better about my life if I felt more comfortable in social \nsituation s?\nU\u00caWhat type of person would I like to be, and how is my social anxiety pre -\nventing me from being that type of person?\nU\u00caWhat sorts of things do I miss about my life before social anxiety became \nas big a problem as it is now?\nRecord your reasons for changing in the space below.\nNow that you have had a chance to consider the costs and bene\ufb01ts of working on \nyour social anxiety, you are in a better position to make a commitment to working on", "source": "shyness_social.pdf"}
{"id": "54e140729a8e-1", "page_content": "your social anxiety, you are in a better position to make a commitment to working on \novercoming your fears. Assuming that you have decided to go ahead as planned, the \nremainder of this chapter will help you to consider the strategies best suited to your \nindividual needs.", "source": "shyness_social.pdf"}
{"id": "6e0074e02958-0", "page_content": "Making a Plan for Change\n71SETTING GOALS FOR CHANGE\nWithout setting speci\ufb01c goals or objectives, it will be impossible for you to evaluate \nwhether you\u2019re making the changes that you hope to make. Goals can be described in a \nnumber of different ways. First, goals can re\ufb02ect either short-term  or long-term  changes that \nyou would like to accomplish. For example, if you have a fear of public speaking, a rea -\nsonable one-week goal might be to ask a single question at a meeting at work, regardless \nof how anxious you feel. A six-month goal might be to give a thirty-minute presentation \nwithout feeling signi\ufb01cant anxiety. As you go through the process of overcoming your \nsocial anxiety, it is important to identify short-term goals (for example, what you want to \naccomplish this week), medium-range goals (such as what you want to accomplish over \nthe next few months), and long-range goals (for instance, what you want to accomplish \nover the next year or two).\nGoals also can be described either as speci\ufb01c  or general . A speci\ufb01c goal is more detailed \nthan a general one. Therefore, speci\ufb01c goals are often better suited for guiding you in \nselecting appropriate treatment strategies, compared with general goals. Also, with spe -\nci\ufb01c goals, it is easier to measure whether your objectives are being met. Although it is \nokay to have a few general goals, you also should try to generate as many speci\ufb01c goals \nas possible. Examples of general and speci\ufb01c goals are listed below.\nGeneral Goal Speci\ufb01c Goal\nTo be more comfortable during \npresentationsTo have my fear level during presentations at my", "source": "shyness_social.pdf"}
{"id": "6e0074e02958-1", "page_content": "To be more comfortable during \npresentationsTo have my fear level during presentations at my \nweekly sales meetings decrease from a level of 100 \nout of 100 to a level of 40 out of 100\nTo ask someone on a date \nsometimeTo ask John (or Jane) to have dinner with me by the \nend of this month\nTo have more friends To meet at least three new friends by the end of this \nyear, with whom I can see movies or watch sports\nTo be comfortable in crowds To be able to walk through a crowded mall or on a \ncrowded street with my fear below a 30 or 40 out \nof 100\nTo cope better with criticism To be able to tolerate negative feedback on my \nannual performance review at work without becom -\ning very upset and while still paying attention to all \nmy positive achievements over the year\nTo ask questions in class To ask at least one question during each class over \nthe rest of this semester\nTo deal better with groups To be able to make small talk at a party while main -\ntaining eye contact and speaking loudly enough for \nothers to hear", "source": "shyness_social.pdf"}
{"id": "28dff71a6120-0", "page_content": "The Shyness & Social Anxiety Workbook\n72Now, think about what types of changes you would like to make. Speci\ufb01cally, think \nabout aspects of your social anxiety (anxious beliefs, situations that you avoid, and so \non) that you would like to change. Try to be realistic. Also, recognize that your goals \nmay change. For example, right now you may not need to make presentations in your \ndaily life. However, if you take a job that involves public speaking, your goals may have \nto be revised later to re\ufb02ect this change.\nWe have included space for you to record your goals for the next month as well as \nyour goals for one year from now. Of course, if you prefer, you may choose other time \nperiods. The main point to remember is that you may have different short-term and \nlong-term goals. Although some goals may be realistic targets for a year or two from \nnow, they may not be realistic goals for one week or one month from now.\nOne-Month Goals\n 1.  \n 2.  \n 3.  \n 4.  \n 5.  \n 6.  \n 7.  \n 8.  \n 9.  \n10.", "source": "shyness_social.pdf"}
{"id": "a60bccfa81de-0", "page_content": "Making a Plan for Change\n73One-Year Goals\n 1.  \n 2.  \n 3.  \n 4.  \n 5.  \n 6.  \n 7.  \n 8.  \n 9.  \n10.  \nREVIEWING PREVIOUS ATTEMPTS TO TREAT \nYOUR SOCIAL ANXIETY\nThis section has two purposes. First, if you\u2019ve tried to overcome your social anxiety in \nthe past, it will help you review the treatments that worked for you and those that were \nnot especially helpful. Second, this section will help you to identify possible reasons \nwhy certain previous attempts to overcome your social anxiety were not useful, if this \nwas your experience. By identifying the reasons for previously successful and not-so-\nsuccessful treatment attempts, you will be able to make more educated decisions about \nwhat types of strategies to try now. If a treatment has worked well in the past, you may \nwant to try it again. If you did not bene\ufb01t from a particular treatment previously, you \nmay want to try something new. However, you should still consider giving a particular \ntreatment another try if you didn\u2019t give it a fair chance the \ufb01rst time.\nIn the spaces that follow, check off any treatments that you have tried in the past. \nAlso, describe the treatment and record whether the outcome was helpful.", "source": "shyness_social.pdf"}
{"id": "783ea8c3345c-0", "page_content": "The Shyness & Social Anxiety Workbook\n74Record of Previous Treatments\nYes No Treatment\n  Medications  \nIf yes, list drug names, duration of treatment, and maximum dosage \nfor each. Also, describe any side effects that you experienced and \nwhether or not each medication helped. Indicate if you took the \nmedication as prescribed.\n \n \n \n \n \n  Exposure to Feared Situations  \nIf yes, describe the treatment (including frequency of exposures, \nduration of treatment, types of situations practiced in, outcome).\n \n \n \n \n \n  Cognitive Therapy (This therapy is focused on teaching strategies for \nchanging anxious thinking; it usually includes completion of thought \nrecords as a component.) If yes, describe the treatment (including \nduration of treatment, outcome).\n \n \n \n \n  Skills Training (This might include assertiveness training or a public \nspeaking or communications course.) If yes, describe the treatment \nor course content (including duration of treatment, outcome).", "source": "shyness_social.pdf"}
{"id": "9241d296ffff-0", "page_content": "Making a Plan for Change\n75 \n \n \n \n  Insight-Oriented Therapy (This therapy is focused on early-childhood \nexperiences and on helping you to understand the deep causes \nunderlying a particular problem.) If yes, describe the treatment \n(duration of treatment, outcome).\n \n \n \n \n \n  Supportive Therapy (In this fairly unstructured therapy, the client \ndescribes experiences over the past week and the therapist offers \nsupport and perhaps suggestions for solving problems that arise \nfrom week to week.) If yes, describe the treatment (duration  \nof treatment, outcome).\n \n \n \n \n \n  Self-Help Book\nIf yes, describe the treatment. (For instance, what book/s did you \nread? What approach did the book take? Did it help?)", "source": "shyness_social.pdf"}
{"id": "31092df4ddfb-0", "page_content": "The Shyness & Social Anxiety Workbook\n76Now that you have identi\ufb01ed speci\ufb01c treatments you have tried in the past, the next \nstep is to understand why a treatment was ineffective or only partially effective, if that \nwas your experience. Listed below are some of the reasons why psychological treatments \nand medications are occasionally not helpful.\nWhy Psychological Treatments Sometimes Don\u2019t Help\nU\u00caThe therapy is an ineffective treatment for social anxiety. Many types of \npsychotherapy have never been studied for the treatment of social anxiety, \nand others have been found to be of little bene\ufb01t. (Cognitive behavioral \ntherapy is the best-studied approach and is well supported.)\nU\u00caThe therapist is inexperienced either with the type of therapy being offered \nor the treatment of shyness and social anxiety, in particular.\nU\u00caThe frequency and intensity of exposure practices is too low. If you practice \nexposure to social situations too infrequently, you will be less likely to see \nthe desired results.\nU\u00caThe treatment does not last long enough. You may not have bene\ufb01ted from \nprevious therapy if you dropped out of treatment before positive results \ncould be seen.\nU\u00caAn individual expects the treatment to be ineffective. There is evidence that \na person\u2019s expectations can affect the outcome of psychotherapy (Safren, \nHeimberg, and Juster 1997).\nU\u00caThe person does not comply with the treatment. If you miss sessions, arrive \nlate for sessions, or don\u2019t complete homework, therapy is less likely to be \neffective.\nU\u00caThere are other problems or stresses in the person\u2019s life that interfere with \ntreatment (for example, severe depression, alcohol abuse, stressful job,", "source": "shyness_social.pdf"}
{"id": "31092df4ddfb-1", "page_content": "treatment (for example, severe depression, alcohol abuse, stressful job, \nmarital problems, health issues).\nWhy Medications Sometimes Don\u2019t Help\nU\u00caIt is the wrong medication for the problem. Some medications have been \nshown to be more effective than others for treating social anxiety (see \nchapter 5). Furthermore, a medication that works for one person may not \nbe the best choice for someone else.\nU\u00caThe medication dosage is not high enough.\nU\u00caThe treatment does not last long enough. Some medications can take up to \nsix weeks to have an effect. Also, stopping certain medications too soon can \nincrease the chances of the anxiety coming back.", "source": "shyness_social.pdf"}
{"id": "81b09d1ccbf9-0", "page_content": "Making a Plan for Change\n77U\u00caAn individual expects the treatment to be ineffective. As with psychother -\napy, there is evidence that a person\u2019s response to medication is affected by \nhis or her expectations.\nU\u00caThe side effects are too unpleasant to tolerate.\nU\u00caThe person is using drugs, drinking alcohol, or taking other medications \nthat in\ufb02uence the effects of the medication for social anxiety.\nU\u00caThe person doesn\u2019t comply with the treatment (for example, misses pills).\nIf you have tried to overcome your social anxiety in the past, but found treatment \nto be ineffective or only partially effective, do you have any guesses about why it may \nnot have worked as well as you had hoped it would? Based on your previous experiences \nwith therapy or medication, are there strategies that you want to try again?\n 1.  \n 2.  \n 3.  \nAre there strategies that you de\ufb01nitely don\u2019t think you should try again?\n 1.  \n 2.  \n 3.  \nPROVEN STRATEGIES FOR OVERCOMING \nSOCIAL ANXIETY\nThere are hundreds of different approaches that people have used to overcome emo -\ntional dif\ufb01culties, behavior problems, and bad habits. Some of these approaches include \npsychotherapy, medications, prayer, relaxation training, yoga, hypnosis, distraction, \ndrinking alcohol or using drugs, exercise, changing diet, reward and punishment, herbal \nremedies, traditional remedies, acupuncture, education and reading about the problem, \npast-life regression, and so forth. Furthermore, each of these methods can be subdivided \ninto even more categories. For example, there are many different types of psychotherapy", "source": "shyness_social.pdf"}
{"id": "81b09d1ccbf9-1", "page_content": "into even more categories. For example, there are many different types of psychotherapy \nand medications, some of which are more useful than others for a particular problem.", "source": "shyness_social.pdf"}
{"id": "094c7386b4dd-0", "page_content": "The Shyness & Social Anxiety Workbook\n78Given all of the different available options, it can be very dif\ufb01cult for a consumer to \nselect the best approach for overcoming a particular problem.\nFor most of the methods listed previously, there is almost no controlled research \nexamining their use in treating anxiety in general and social anxiety in particular. The \nterm controlled  is used to describe studies in which the investigators have examined the \neffects of a particular treatment while taking steps to ensure that any improvements that \noccur are, in fact, due to the treatment, rather than to other factors. Note that a lack \nof controlled research does not mean that a particular treatment is ineffective. It simply \nmeans we just don\u2019t know whether the treatment works or how well it works.\nEven if someone seems to improve after using one of these methods, it can be dif -\n\ufb01cult to know whether it was the treatment that had a bene\ufb01cial effect or whether other \nfactors contributed to the change. For example, as we mentioned earlier, someone\u2019s \nexpectations of improving during treatment can affect his or her improvement. Other \nreasons why people might improve with a particular treatment may include the passage \nof time. For some types of problems (such as depression), the symptoms may improve \nnaturally over time, regardless of whether the sufferer receives any speci\ufb01c treatments. \nChanges in a person\u2019s normal routines (for instance, a reduction of stress at work) also \ncan contribute to improvements over and above any treatment effects.\nProperly controlled research can help to determine whether the effects of a treat -\nment are indeed due to the treatment rather than to other factors. One strategy used by \nresearchers is the inclusion of a control group. For example, research studies that examine", "source": "shyness_social.pdf"}
{"id": "094c7386b4dd-1", "page_content": "researchers is the inclusion of a control group. For example, research studies that examine \nthe effects of a medication on a particular problem usually give a percentage of the individ -\nuals in the study a placebo , which is, essentially, a pill that contains no real medication. This \ngroup is called the placebo control group . Typically, neither the doctor nor the patient knows \nwhether the person is taking a placebo or the real medication until after the study ends.\nThe test of whether a medication is helpful depends on how well people who took \nthe medication respond compared with those who took the placebo. Including a placebo \ncontrol group allows the researcher to directly measure the effects of the medication over \nand above the effects of the individual\u2019s expectations about the treatment. Properly con -\nducted studies examining the effects of psychological treatments also include appropriate \ncontrol groups to aid in understanding why a particular treatment may appear to work.\nIn this book, we have chosen to focus on techniques that have been shown in con -\ntrolled research to be effective for helping people to overcome problems with social \nanxiety, shyness, and performance-related fears. In other words, these techniques have \nbeen shown to be effective compared with no treatment, placebo treatments, other forms \nof psychotherapy, or other appropriate control groups. The techniques we will focus on \ninclude two main groups of strategies: cognitive behavioral therapy and medications.\nCognitive Behavioral Therapy\nCognitive behavioral therapy, or CBT, includes a group of techniques that are usually \nused together as a package. Numerous studies have shown that CBT is an effective", "source": "shyness_social.pdf"}
{"id": "3396ecdd3622-0", "page_content": "Making a Plan for Change\n79way of overcoming social anxiety (for reviews, see Antony and Rowa 2008; Rodebaugh, \nHolaway, and Heimberg 2004). Cognitive behavioral therapy differs from other more \ntraditional forms of therapy in the following ways:\nU\u00caCBT is directive. In other words, the therapist is actively involved in the \ntherapy and makes very speci\ufb01c suggestions.\nU\u00caCBT\u2019s focus is on changing a particular problem. Some other forms of therapy \nfocus on helping the individual develop insight into or understanding of the \ndeep-rooted causes of a problem but do not offer speci\ufb01c  strategies for \novercoming the problem.\nU\u00caCBT has a relatively brief duration. The typical course for social anxiety is \nten to twenty sessions.\nU\u00caCBT focuses on current beliefs and behaviors, which are thought to be \nresponsible for maintaining the problem. Some traditional therapies tend to \nfocus more on early childhood experiences.\nU\u00caIn CBT, the therapist and client are partners and work together during \ntreatment.\nU\u00caIn CBT, the client chooses the goals for therapy, with input from the \ntherapist.\nU\u00caCBT usually includes strategies for measuring progress so that treatment \ntechniques can be adjusted for maximum effectiveness.\nU\u00caCBT involves changing beliefs and behaviors so that the client is able to \nbetter manage anxiety and to navigate anxiety-provoking situations.\nCognitive behavioral therapy for social anxiety includes three main types of strat -\negies. Treatment almost always includes cognitive therapy and exposure to feared \n situations. In addition, social-skills training is sometimes included.\nCOGNITIVE THERAPY\nThe term cognitive  refers to anything having to do with assumptions, beliefs, predic -", "source": "shyness_social.pdf"}
{"id": "3396ecdd3622-1", "page_content": "The term cognitive  refers to anything having to do with assumptions, beliefs, predic -\ntions, interpretations, visual imagery, memory, and other mental processes related to \nthinking. The basic underlying assumption of cognitive therapy is that negative emotions \noccur because people interpret situations in a negative or threatening way. For example, \npeople who are convinced that others will judge them in a negative way or who are \noverly concerned about the opinions of others are bound to feel anxious or uncomfort -\nable in certain social situations. Cognitive therapy teaches individuals to be more aware \nof their negative thoughts and to replace them with less negative thoughts. People learn", "source": "shyness_social.pdf"}
{"id": "86c07e400738-0", "page_content": "The Shyness & Social Anxiety Workbook\n80to treat their beliefs as guesses about the way things may be, rather than as facts. They \nare taught to examine the evidence supporting their anxious beliefs and to consider the \npossibility that an alternative belief is true.\nFor example, if Henry is very hurt and angry because a friend didn\u2019t return his call, \nthese negative feelings might stem from Henry\u2019s belief that the friend doesn\u2019t care about \nhim. In cognitive therapy, Henry would be taught to consider alternative explanations \nfor the friend\u2019s behavior, including the possibility that the friend never received the \nmessage, forgot to return the call, or is out of town. After all, there are many possible \nreasons why a caring friend might not have returned Henry\u2019s call quickly.\nAt the beginning of treatment, diaries are used to record anxious thoughts and to \ncounter them with more realistic predictions and interpretations. As people become \nmore comfortable with the methods of challenging their unrealistic negative beliefs, their \nnew ways of thinking become more automatic and the diaries are no longer needed. \nPeople learn to manage their anxious thoughts before they get out of control. Cognitive \ntherapy techniques are described in detail in chapter 6.\nEXPOSURE\nExposure involves gradually and repeatedly confronting feared situations until they \nno longer trigger fear. In most cases, exposure is viewed as a necessary component of \nCBT. In fact, exposure may be even more powerful than cognitive therapy as a way of \nchanging anxious negative thinking. By exposing yourself to situations you fear, you \nwill learn that the risk in these situations is minimal. Through direct experience, many \nof your anxious predictions and beliefs will be proven incorrect. You will also learn \nto better tolerate situations in which some of your beliefs actually may be true (for", "source": "shyness_social.pdf"}
{"id": "86c07e400738-1", "page_content": "to better tolerate situations in which some of your beliefs actually may be true (for \nexample, when another person actually does judge you negatively). Finally, exposure will \nprovide you with an opportunity to practice your cognitive therapy skills and to improve \nupon any social or communication skills that may be rusty from having avoided social \nsituations for so long. See chapters 7 through 9 for detailed instructions for designing \nand implementing exposure exercises.\nIMPROVING SOCIAL SKILLS\nSocial-skills training refers to the process of learning to improve the quality of your \ncommunication as well as other social behaviors, so there will be an increased likelihood \nof obtaining a positive response from others. Note that most people who are socially \nanxious have better social skills than they think they do. In fact, formal social-skills train -\ning is often not included in CBT programs, and people undergoing the treatment still \nrespond quite well. Still, there is evidence that some people can bene\ufb01t from learning a \nfew new techniques to become more assertive, make small talk more effectively, improve \ntheir eye contact, and learn basic skills for dating or meeting new people. Chapter 10 \ndescribes strategies for improving social and communication skills.", "source": "shyness_social.pdf"}
{"id": "8d7e3fae0361-0", "page_content": "Making a Plan for Change\n81Medications\nNumerous medications have been shown to be effective for treating social phobia \n(Van Ameringen, Mancini, and Patterson, in press). Mostly, these include certain anti -\ndepressants that also target anxiety (such as paroxetine and venlafaxine) and certain \nanti-anxiety drugs (for instance, clonazepam). Typically, medications are taken on a \ndaily basis. To varying degrees, all medications are associated with certain side effects. \nHowever, for most people, these side effects are quite manageable and most tend to \ndecrease over time.\nOther Treatments\nThere are a number of other therapies that have preliminary or limited research \nsupport for treating social anxiety. Some of these treatments are quite new, and all of \nthem have only been investigated in one or more studies for social anxiety (most of \nwhich are not controlled studies). Though it is too early to know if these therapies are as \n effective as CBT and medications, here are some brief descriptions of these approaches:\nMINDFULNESS TRAINING\nMindfulness training involves learning to focus on one\u2019s present experiences (for \nexample, thoughts and feelings) without judging them or trying to change them and \nwithout dwelling on the past or anticipating the future (see Orsillo and Roemer 2005). \nMeditation is often a component of mindfulness training. Preliminary evidence sup -\nports the use of mindfulness for treating general worries (Roemer and Orsillo 2007) \nand for preventing relapse in depression (Williams et al. 2007). Evidence from a recent \npilot study suggests that mindfulness training may be useful for treating social anxiety \n(B\u00f6gels, Sijbers, and Voncken 2006).\nACCEPTANCE AND COMMITMENT THERAPY (ACT)", "source": "shyness_social.pdf"}
{"id": "8d7e3fae0361-1", "page_content": "ACCEPTANCE AND COMMITMENT THERAPY (ACT)\nACT is a relatively new form of therapy that is related to mindfulness training in \nthat a goal of this treatment is to teach people to accept their experiences (includ -\ning emotions, thoughts, imagery, and other experiences) rather than trying to control, \n\ufb01ght, or change them (Hayes and Smith 2005). Mindfulness training is used as part of \nACT, but other strategies are used as well. In addition to acceptance, people receiving \nACT are also encouraged to make a commitment to live a life that is consistent with \ntheir own values and goals, which typically involves changing behaviors. Though ACT \nis often presented as an alternative to CBT, it actually overlaps with CBT quite a bit. \nFor example, ACT for anxiety and CBT for anxiety both use exposure as a component \n(Eifert and Forsyth 2005). A preliminary, uncontrolled study suggests that ACT may \nlead to  reductions in social anxiety (Ossman et al. 2006).", "source": "shyness_social.pdf"}
{"id": "e39e5a95fd85-0", "page_content": "The Shyness & Social Anxiety Workbook\n82APPLIED RELAXATION TRAINING\nApplied relaxation involves the combination of learning to relax the muscles of the \nbody with exposure to increasingly challenging situations. A few studies suggest that \napplied muscle relaxation may be useful for social anxiety (Jerremalm, Johansson, and \n\u00d6st, 1980; Osberg 1981). However, it is dif\ufb01cult to know whether this approach is effec -\ntive because of the relaxation component, the exposure to feared situations, or both. \nThere are no studies investigating whether relaxation training adds any bene\ufb01t over and \nabove the effects of exposure alone.\nINTERPERSONAL PSYCHOTHERAPY (IPT)\nIPT is a brief therapy that focuses exclusively on interpersonal aspects of a person\u2019s \nproblem, such as problems in the individual\u2019s relationships with others. IPT has been \nstudied primarily in people who are depressed, and it\u2019s been shown in a number of well-\ncontrolled studies to be an effective treatment for depression, as well as certain other \nproblems (Weissman, Markowitz, and Klerman 2007). Because of the interpersonal focus \nof IPT, some researchers have wondered whether it might also be effective for treating \nsocial anxiety. A preliminary, uncontrolled study (Lipsitz et al. 1999) suggests that IPT \nmay be useful for treating social anxiety, though more research is needed.\nCHOOSING AMONG TREATMENT OPTIONS\nIf you decide to try medications, you will probably need to get a prescription from a \nphysician\u2014usually your family doctor or a psychiatrist. However, note that in some \nstates other professionals (for example, nurse practitioners) may be able to prescribe \nmedications. In fact, two states (New Mexico and Louisiana) now allow psychologists", "source": "shyness_social.pdf"}
{"id": "e39e5a95fd85-1", "page_content": "medications. In fact, two states (New Mexico and Louisiana) now allow psychologists \nwith appropriate training to prescribe medications as well. For most people, a visit to \nyour family doctor is a good place to start if you are interested in trying medications. \nHe or she can make a referral to a psychiatrist or other professional if needed. If you \nare interested in trying a psychological treatment such as CBT, you have the option of \ntrying to overcome the problem on your own or seeking professional help.\nSelf-Help or Professional Help?\nFor some people, a self-help approach such as that described in this book may be \nsuf\ufb01cient. In fact, a study by Moore, Braddock, and Abramowitz (2007) found that \nmost people who used the \ufb01rst edition of this book achieved signi\ufb01cant reduction in \ntheir social anxiety, even without any additional therapy. However, for others, a self-help \nbook alone is not enough, and many people \ufb01nd that the added structure and support \nprovided by a therapist is important. If you decide to seek professional help, this book", "source": "shyness_social.pdf"}
{"id": "a35a1c4724e9-0", "page_content": "Making a Plan for Change\n83can still help to reinforce what you learn in therapy. An important part of CBT involves \neducating the client (often using self-help readings) and encouraging the client to prac -\ntice the various CBT techniques between sessions. In other words, CBT conducted with \na therapist often includes a self-help component. Combining a self-help book with your \ntherapy may even reduce the number of therapy sessions needed (Rapee et al. 2007). \nFor more information on \ufb01nding a therapist, see the section on seeking professional help \nthat appears later in this chapter.\nCognitive Behavioral Therapy or Other Psychotherapy?\nIn almost all cases, we recommend cognitive therapy and exposure as the psycho -\nlogical treatment of choice for social phobia. Adding social-skills training to the program \nmay be useful for some individuals as well. As for other psychological therapies, although \nthey certainly have a place for treating certain types of problems, they are not suf\ufb01ciently \nproven when it comes to treating social phobia and other anxiety-related conditions.\nSome people with whom we have worked have reported bene\ufb01ts from combining \nCBT with another form of psychotherapy. In these cases, typically they have seen one \ntherapist for CBT and another for dealing with other issues (for example, marital prob -\nlems, coping with childhood abuse). Although this approach sometimes works well, we \nrecommend that your two therapists stay in close contact with each other so that they \ncan ensure they are not giving you contradictory messages during therapy.\nMedication or CBT?\nA number of studies have investigated whether CBT, medications, or their combina -\ntion work best (Antony and Rowa 2008). Although there are some differences across", "source": "shyness_social.pdf"}
{"id": "a35a1c4724e9-1", "page_content": "studies, the overall pattern of \ufb01ndings has been that all three of these approaches are \nabout equally effective, at least in the short term. For example, in the largest study \nconducted to date, CBT, \ufb02uoxetine (an antidepressant), and a combination of \ufb02uoxetine \nand CBT were all found to be about equally effective and were all more effective than \nplacebo (Davidson et al. 2004).\nAlthough these approaches are about equally effective in the short term, CBT tends \nto be a more effective treatment than medications over the long term (Liebowitz et al. \n1999). In other words, once all treatments have stopped, people who have been only \ntaking medications are more likely to experience a return of symptoms than people who \nhad CBT. \nAlso, just because these three approaches are about equally effective on average , that \ndoesn\u2019t mean that they are equally likely to be effective for you . Some people seem to do \nbetter with medications, whereas others seem to do best with CBT or a combination of \nthese approaches. The approach we usually recommend is to start with either CBT or \nmedication, and then introduce the other treatment after several months, if needed.", "source": "shyness_social.pdf"}
{"id": "851dc23ccd57-0", "page_content": "The Shyness & Social Anxiety Workbook\n84Group or Individual Therapy?\nCognitive behavioral therapy can be delivered either individually or in groups. Both \napproaches work well. Although most studies have found group and individual thera -\npies for social anxiety to be about equally effective, some have found an advantage for \n individual therapy (for a review, see Bieling, McCabe, and Antony 2006).\nRegardless of which approach you choose, you should be aware of the advantages \nand disadvantages of each. Group treatment gives people an opportunity to meet other \npeople with the same problem. This allows people to learn from the mistakes and suc -\ncesses of others and reminds them that they are not the only ones suffering from this \nproblem. Group treatment also provides clients with opportunities to interact with other \nindividuals who can participate in exposure exercises and role-play practices. For example, \ngroup members can be an audience during exposures that involve giving presentations.\nThe cost is another advantage of group therapy. Because you are sharing the thera -\npist\u2019s time with other people, the cost per session is often lower than for individual \ntherapy. If you decide to enter group treatment for social anxiety, we recommend that \nyou try to \ufb01nd a group that focuses exclusively on anxiety problems, and ideally on \nsocial anxiety (rather than a group that includes people who suffer from a wide range of \ndifferent problems). You are most likely to \ufb01nd a specialized social anxiety group at an \nanxiety disorders specialty clinic.\nIndividual therapy also has advantages. First, it can be less scary than group therapy, \nparticularly at the beginning. As you can imagine, people with social phobia are often \nquite terri\ufb01ed of starting group treatment, although anxiety about speaking in front", "source": "shyness_social.pdf"}
{"id": "851dc23ccd57-1", "page_content": "quite terri\ufb01ed of starting group treatment, although anxiety about speaking in front \nof the group usually diminishes after the \ufb01rst few weeks. Furthermore, with individual \ntherapy, you don\u2019t have to share your time with other group members. And, because \nthere is more time to focus on you, the program can be individually tailored to suit your \npersonal needs. Individual therapy also has advantages from a scheduling perspective. If \nyou miss a session due to illness or vacation, usually you can just reschedule an individual \nappointment. In contrast, if you miss a group session, catching up on the material that \nyou missed may be more complicated.\nWhether you decide to seek group or individual treatment should depend on a \ncareful weighing of all of these factors. Keep in mind, however, that you may not have a \nchoice. Although the availability of CBT is increasing, this form of therapy is still hard \nto \ufb01nd in some places, either in a group or individual format. We would like to empha -\nsize that, in choosing a therapy, the most important factor is \ufb01nding a therapist who has \nexperience in providing CBT for social anxiety. Whether you choose group or individual \ntherapy should be a secondary issue, since both seem to work well.\nTHE IMPORTANCE OF REGULAR PRACTICE \nAlthough simply reading about how to overcome social phobia may be helpful, to make \nbig changes in your social anxiety, it will be necessary for you to actually practice the", "source": "shyness_social.pdf"}
{"id": "09185e519c15-0", "page_content": "Making a Plan for Change\n85techniques described throughout this book. For example, you will get more out of \nthe cognitive strategies described in chapter 6 if you complete the monitoring forms \nand diaries and frequently take advantage of opportunities to challenge your anxious \nbeliefs.\nTo get the most out of exposure practices, it will be important to enter feared \nsituations as frequently as possible and to stay in the feared situations until your fear \nhas decreased, or until you learn that your feared consequences don\u2019t occur. Many of \nyour exposure practices can be conducted during the course of your everyday life (for \ninstance, having lunch with coworkers instead of eating alone), but other practices may \nrequire you to set aside time just for the exposure exercises.\nINCLUDING A HELPER OR CO-THERAPIST\nIt may be helpful to involve a helper or \u201cco-therapist\u201d in your treatment, for example, \na friend, coworker, or family member. Your helper can provide you with opportunities \nto practice role-play exposures, such as presentations, simulated job interviews, making \nsmall talk, or asking another person out on a date. In addition, he or she can provide you \nwith honest feedback about your performance and offer suggestions for improvement.\nWhen choosing other people to help you out, we suggest that you select people \nwhom you trust. The person should be someone who is supportive and unlikely to \nbecome frustrated or angry if things move slowly or if you are \ufb01nding a particular situa -\ntion dif\ufb01cult or anxiety provoking. If possible, your helper should read relevant sections \nof this book so that he or she has a better understanding of the treatment and how it \nworks. If this is not practical, an alternative option would be to have you describe to your", "source": "shyness_social.pdf"}
{"id": "09185e519c15-1", "page_content": "helper what his or her role will be during the practices.\nDEALING WITH ADDITIONAL PROBLEMS\nMany people who suffer from social anxiety also experience other problems, includ -\ning other anxiety disorders, depression, alcohol or drug use problems, and relationship \n dif\ufb01culties. In most cases, these other problems tend not to interfere with the treatment \nof social anxiety. However, if you are currently suffering from problems in addition \nto your shyness, there are two questions that you should consider. First, is your social \nanxiety the most important problem to focus on currently? If not, you should probably \nfocus on the problem that is interfering the most with your life. For example, if your \ndepression is more severe than your social anxiety, it may be important to deal with your \ndepression \ufb01rst and then turn your attention to the social anxiety when your depression \nis under control. Second, are your other problems so severe that they are likely to get in \nthe way of your social anxiety treatment? If so, you should work on the other problems \n\ufb01rst. For example, if you are drinking alcohol so frequently that you\u2019re unlikely to follow", "source": "shyness_social.pdf"}
{"id": "d52322d6f051-0", "page_content": "The Shyness & Social Anxiety Workbook\n86through with the exercises in this book, then dealing with your drinking before working \non your social anxiety is a good idea.\nSEEKING PROFESSIONAL HELP\nIf you are interested in seeking professional help for your social anxiety, here are some \nadditional suggestions to keep in mind.\nHow to Find a Therapist or Doctor\nOne of the most dif\ufb01cult aspects of \ufb01nding a therapist or doctor is knowing where \nto look. A good place to begin is with your family doctor, who will likely be aware \nof psychiatrists, psychologists, and anxiety specialty clinics in your area. You may also \nwant to call nearby hospitals and clinics to see if they have programs that offer either \nCBT or medication for social anxiety. The Internet is also a great source of information \nabout treatment options in your area. Check with your insurance company about the \nrules regarding coverage for treatment of psychological conditions. Your plan may have \nrestrictions regarding who you can see and the number of sessions that are covered.\nAnother way to \ufb01nd help is to contact a national organization that focuses either \non anxiety-related problems or CBT. For example, the Anxiety Disorders Association of \nAmerica (www.adaa.org) offers information about treatment options and self-help groups \nacross the United States and Canada (the ADAA has both consumer and professional \nmembers). The Association for Behavioral and Cognitive Therapies (www.abct.org) is \na professional organization that also provides information on practitioners who treat \nanxiety-related problems. Full contact information for these and other organizations is \nprovided in the resources section at the back of this book. You may also contact your \nstate psychological or psychiatric associations to get information about psychologists or \npsychiatrists in your area.", "source": "shyness_social.pdf"}
{"id": "d52322d6f051-1", "page_content": "psychiatrists in your area.\nWhen choosing a professional, don\u2019t be afraid to ask questions. Before making a \ncommitment, here are some issues that you should clarify:\nU\u00caThe type of treatment being offered. For example, if you are interested in a \npsychological treatment, you should ask whether the person is experienced \nin providing CBT for social and performance anxiety.\nU\u00caThe typical number of sessions recommended for treating this problem, rec -\nognizing that it is often dif\ufb01cult to know this before conducting a thorough \nassessment. In many cases, ten to twenty sessions is enough.\nU\u00caThe length of each session. One-hour sessions are typical, though longer \ntime periods are sometimes needed for exposure sessions.", "source": "shyness_social.pdf"}
{"id": "023c5a9dabd4-0", "page_content": "Making a Plan for Change\n87U\u00caThe frequency of sessions. Weekly sessions are typical.\nU\u00caThe cost per session and preferred method of payment. Are the fees \n\ufb02exible?\nU\u00caThe location and setting. For example, is the treatment conducted in \na private of\ufb01ce? A hospital? A university clinic? A community clinic? A \nresearch center?\nU\u00caThe availability of group vs. individual treatments for social anxiety. Either \napproach is likely to help.\nU\u00caWho provides the treatment? A psychologist? Psychiatrist? Psychology \nstudent or psychiatric resident? How experienced is the person? Where \nwas he or she trained? If it is a student therapist, how closely is he or she \nsupervised? How experienced is the supervisor? Can you meet with the \nsupervisor if you wish?\nTypes of Professionals\nIf you are interested in receiving a psychological therapy, like CBT, your therapist \ncan be a psychologist, physician, nurse, social worker, or professional from any of a \nnumber of other backgrounds. However, keep in mind that most practicing clinicians, \nregardless of their background, do not have extensive experience in providing CBT \nfor anxiety-related problems. It is much more important that you \ufb01nd someone who is \nfamiliar with treating social anxiety using cognitive and exposure-based treatments than \nwhat degree the person has. Currently, psychologists are the most likely to have this \nbackground, but other professionals are increasingly being trained in providing cognitive \nand behavioral treatments.\nUnderstanding the differences between types of therapists often can be confusing. \nA brief description of some of the main professionals who often provide CBT and related \ntreatments follows:\nPsychologist.  In most places, psychologists who specialize in treating psychological dis -", "source": "shyness_social.pdf"}
{"id": "023c5a9dabd4-1", "page_content": "Psychologist.  In most places, psychologists who specialize in treating psychological dis -\norders usually have a doctoral degree in clinical or counseling psychology. Often, this \ndegree is a Ph.D. (which includes signi\ufb01cant training in both research and in providing \nclinical care), although it may also be a Psy.D. (indicating a primary training focus on \nproviding clinical services and relatively less emphasis on research) or an Ed.D. (indi -\ncating training that stems from an educational psychology perspective). Typically, the \ntraining of a psychologist includes an undergraduate bachelor\u2019s degree (four years), fol -\nlowed by an additional \ufb01ve to eight years of graduate training. In some states and prov -\ninces, psychology practitioners with a master\u2019s degree (usually two years of graduate \ntraining) can also call themselves psychologists, whereas in other places, master\u2019s level", "source": "shyness_social.pdf"}
{"id": "eddaf7a1036f-0", "page_content": "The Shyness & Social Anxiety Workbook\n88 clinicians are called by other terms (for example, psychological associate, psychothera -\npist, psychometrist).\nPsychiatrist.  A psychiatrist is a physician who has specialized in treating mental health \nproblems after completing four years of medical school. Typically, this specialty train -\ning includes a \ufb01ve-year residency and also may include additional fellowship training. \nPsychiatrists are more likely than other types of professionals to understand and treat \nanxiety from a biological perspective, although increasingly, psychiatric training pro -\ngrams are requiring training in CBT. Advantages of being treated by a psychiatrist over \nother types of professionals include the opportunity to obtain medications in addition \nto other forms of therapy, as well as the opportunity to be assessed by a physician who \nis uniquely quali\ufb01ed to recognize medical conditions that may be contributing to the \nproblem.\nSocial worker.  Social workers are trained to do many different things including helping \npeople to deal better with their relationships, solve their personal and family problems, \nand learn to cope better with day-to-day stresses. They may help people to deal with \nthe stresses of inadequate housing, unemployment, lack of job skills, \ufb01nancial distress, \nserious illness or disability, substance abuse, unwanted pregnancy, and other hardships. \nMost social workers specialize, and some end up providing psychotherapy either in a \nprivate practice or a hospital or agency setting. Although CBT is seldom a formal part \nof social-work training programs, some social workers obtain specialized training in CBT \nfollowing their formal schooling.\nOther professions.  Professionals from a variety of other groups may be trained to \nprovide CBT or other forms of psychotherapy. These include some family physicians, \nnurses, occupational therapists, clergy or other religious leaders, and even psychothera -", "source": "shyness_social.pdf"}
{"id": "eddaf7a1036f-1", "page_content": "nurses, occupational therapists, clergy or other religious leaders, and even psychothera -\npists without any formal degree in a mental-health related \ufb01eld. As mentioned earlier, \nit is more important to know whether the person you\u2019re seeing has the experience and \nexpertise in treating social anxiety using strategies that have been proven to be useful \nthan whether the person is a nurse, family doctor, psychologist, psychiatrist,  occupational \ntherapist, social worker, or a student in one of these \ufb01elds.\nFINAL QUESTIONS REGARDING TREATMENT  \nOF SOCIAL ANXIETY\nHere are some answers to a few additional frequently asked questions.\nHow long does treatment take?  As mentioned earlier, cognitive behavioral treatment \nfor social and performance anxiety typically takes between ten and twenty sessions. \nSometimes a person may make signi\ufb01cant gains after just three or four sessions, par -\nticularly if the fear is very mild. Other times, treatment may last many months or even", "source": "shyness_social.pdf"}
{"id": "36f0358cedf0-0", "page_content": "Making a Plan for Change\n89years. If you are being treated with medication (particularly antidepressants), it is usually \nrecommended that you stay on the medication for six months to a year or more before \nslowly decreasing the dosage and eventually discontinuing the medication. If the symp -\ntoms return, it may be necessary to resume taking the medication or to try a  different \nform of treatment.\nAre the effects of treatment long lasting?  As we discussed earlier, the effects of CBT \ntend to be relatively long lasting, although you may experience some bad days occasion -\nally. In contrast, stopping medication treatment suddenly is more likely to lead to a return \nof the anxiety. You can protect against this to some degree by staying on the medication \nfor a longer period (perhaps at a reduced \u201cmaintenance\u201d dosage) and by stopping the \nmedication very gradually. Also, stopping certain types of medications is more likely to \nlead to a return of symptoms than stopping other medications, as reviewed in chapter \n5. It is advisable to discuss reducing or stopping medication with the professional who is \nprescribing it for you before you change the dose you\u2019re taking.\nWill you be completely \u201ccured\u201d?  A small percentage of people who have signi\ufb01cant \nsocial anxiety are able to reach a point at which they rarely experience any social anxiety \nat all. Similarly, a small percentage of people do not obtain any bene\ufb01t from either \nCBT or medications. For most people, however, the result of treatment is somewhere in \nbetween these two extremes. It is realistic to expect that proper treatment is likely to \nlead to a signi\ufb01cant decrease in your social anxiety, avoidance behaviors, and impairment \nof day-to-day life. However, it is also likely that there will remain some situations that", "source": "shyness_social.pdf"}
{"id": "36f0358cedf0-1", "page_content": "will still be anxiety provoking, at least to some extent. This outcome may not seem too \nbad if you remember that most people experience social and performance anxiety from \ntime to time.\nWhat if you don\u2019t like your therapist or doctor?  Although it is unrealistic to expect \nto be feeling better after only a few weeks, you should know after one or two meet -\nings whether you are comfortable working with your therapist or doctor. If you are not \npleased with how things are going, consider trying someone else. Within six to eight \nweeks after beginning either CBT or medication, you should begin to see changes. If \nchanges have not occurred after two months, you should talk to your doctor or therapist \nabout the possible reasons for the lack of improvement and consider other treatment \noptions.\nMEASURING CHANGE DURING TREATMENT\nIn chapter 3, we emphasized the importance of monitoring your progress throughout \nyour treatment program. We recommend that periodically (every few weeks) you re\ufb02ect \non your progress by considering what types of changes you have made and what changes \nremain to be accomplished. Depending on your progress, you may decide to revise your", "source": "shyness_social.pdf"}
{"id": "1c0ec08e2c4d-0", "page_content": "The Shyness & Social Anxiety Workbook\n90treatment plan. You may also decide to update your treatment goals. We recommend \nthat you occasionally complete some of the forms in chapter 3 as a way of assessing \nwhether your social anxiety is improving.\nDEVELOPING A COMPREHENSIVE  \nTREATMENT PLAN\nIn chapters 1 and 2, you learned about the nature and causes of social anxiety. In chapter \n3, you completed a thorough assessment of your own anxiety symptoms. Then, you \ncontinued the self-assessment process throughout this chapter, as you reviewed your \nprevious attempts at treatment and developed your treatment goals. You are now ready \nto develop a treatment plan. By now, you should have a good idea of what you need to \nwork on and whether you will try to overcome your social anxiety on your own or with \nthe help of a professional therapist or physician.\nIf you are considering trying medication, we recommend that you read chapter 5 \nnext. Chapter 5 reviews the various medications that have been shown to be useful for \ntreating social and performance anxiety. If you are interested in trying cognitive behav -\nioral techniques, we suggest that you develop a treatment schedule for the next few \nmonths. The following list is one example of such a schedule:\nU\u00caIn the next week, read chapter 6 and begin to work on changing your neg -\native thinking patterns. Chapter 6 includes a number of effective cogni -\ntive strategies as well as diaries that you should complete several times per \nweek.\nU\u00caContinue to practice the cognitive strategies for two to three weeks before \nmoving on to exposure-based techniques (chapters 7 through 9).\nU\u00caWhen you are ready to begin exposure practices, begin reading chapters 7", "source": "shyness_social.pdf"}
{"id": "1c0ec08e2c4d-1", "page_content": "U\u00caWhen you are ready to begin exposure practices, begin reading chapters 7 \nand 8. As you read these chapters, you will have the opportunity to plan \nexposures designed speci\ufb01cally for your own pattern of fear and avoidance. \nWe recommend that you practice the situational exposure strategies for \ufb01ve \nor six weeks before moving on to chapter 9.\nU\u00caAt the same time that you are practicing exposures, you should continue to \npractice using the cognitive strategies that you will learn in chapter 6. By \nusing the cognitive strategies and practicing exposures to feared situations, \nyou should notice your fear beginning to decrease.\nU\u00caAfter \ufb01ve or six weeks of practicing exposure to feared situations, read \nchapter 9 to learn more about how to expose yourself to feared physical \nsensations. If you are frightened of feeling certain sensations when you are \nanxious, we recommend that you spend two to three weeks practicing the", "source": "shyness_social.pdf"}
{"id": "b932213bc11a-0", "page_content": "Making a Plan for Change\n91strategies described in chapter 9. At the same time, continue to practice the \ncognitive and exposure techniques from the earlier chapters.\nU\u00caIf there are social skills that you would like to improve, this will be the time \nto use the exercises described in chapter 10. Again, we recommend that you \ndo not stop using the skills that you learned earlier, particularly the cogni -\ntive and exposure-based strategies.\nAt this point, several months will have passed and your anxiety will be likely to have \nimproved signi\ufb01cantly. We recommend that you read chapter 11 at this point, which \ndiscusses ways of maintaining the gains you have made so far.\nIf you are curious and you want to read later sections in the book now, that\u2019s \ufb01ne. \nHowever, it\u2019s important that you go back and practice the strategies in each chapter \nbefore moving on to the next set of techniques. These strategies are the building blocks \nthat eventually will lead to an improvement in your social anxiety. \nAfter completing this chapter, a number of issues should be clearer to you. First, you \nshould have a better idea of whether this is the best time for you to work on overcoming \nyour social anxiety. Second, you should have formulated a number of treatment goals, \nboth for the short term and the long term. Finally, it is likely that you will have consid -\nered the various treatment options and identi\ufb01ed your own treatment preferences. The \nremaining chapters in this workbook provide more detailed instructions in how to take \nadvantage of particular strategies for managing social anxiety.", "source": "shyness_social.pdf"}
{"id": "8518308415f3-0", "page_content": "CHAPTER 5\nMedications for Social \nAnxiety and Social \nAnxiety Disorder\nDECIDING TO TAKE MEDICATION\nAs discussed in earlier chapters, two approaches have been shown to be useful for over -\ncoming social anxiety: medications and cognitive behavioral therapy (CBT). Chapter 4 \nreviewed the key points to keep in mind when deciding whether to use drug treatments \nto overcome your symptoms of social anxiety. Medications and CBT have been shown \nto be about equally effective in the short term for treating social anxiety. Still, each \napproach has advantages and disadvantages.\nAdvantages of Medications Compared with CBT\nU\u00caMedications are often easier to get. Any physician (for example, family \ndoctor or psychiatrist) can prescribe medications, as can certain other pro -\nfessionals. In contrast, therapists who have specialized training in providing \nCBT are often more dif\ufb01cult to \ufb01nd.", "source": "shyness_social.pdf"}
{"id": "b282e9f70e94-0", "page_content": "The Shyness & Social Anxiety Workbook\n94U\u00caDrug treatments are easy to use and don\u2019t take up much time. You just need \nto remember to take your pills. In contrast, CBT requires a lot of hard work \nand can be time consuming.\nU\u00caMedications often work more quickly than CBT. Depending on the type of \ndrug, changes in anxiety can be observed in as little as an hour for treat -\nment with anti-anxiety medications, and in as little as two to four weeks \nfor treatment with antidepressant medications. Typically, CBT takes several \nweeks to months before signi\ufb01cant changes take place.\nU\u00caMedications are often less expensive in the short term. Visits to your doctor \ncan be infrequent once a stable dosage is reached. At that point, the only \ncost is the medication itself. In contrast, CBT usually requires regular \nvisits to a therapist throughout the treatment and therefore can be costly, \n especially if you have limited coverage through your health insurance.\nDisadvantages of Medications Compared with CBT\nU\u00caAnxiety is more likely to return after stopping medication than after stop -\nping CBT. In other words, the effects of CBT are often longer lasting.\nU\u00caMedication may be more expensive than CBT over the long term. Because \nmedication is typically used for a longer period (often years), the costs are \nlikely to add up to more than the cost of CBT, which generally lasts only \nseveral months.\nU\u00caMany people experience side effects when taking medications. Although \nthese are usually manageable and improve after the \ufb01rst few weeks, some \npeople experience more severe side effects, making treatment with medica -", "source": "shyness_social.pdf"}
{"id": "b282e9f70e94-1", "page_content": "people experience more severe side effects, making treatment with medica -\ntion unpleasant or impossible. The main side effect of CBT is an increase \nin anxiety during exposure to feared situations, and this anxiety resolves \nquickly.\nU\u00caMedications for social anxiety may interact with alcohol and with other \nmedications. They may also cause problems in people who have certain \nmedical illnesses. CBT does not interact in the same ways with alcohol, \nmedications, or medical illnesses.\nU\u00caSome medications are dif\ufb01cult to stop taking because they may cause \nuncomfortable symptoms during discontinuation. This is particularly a \nproblem with anti-anxiety medications, as well as with a few speci\ufb01c anti -\ndepressants. Medications with the potential for dependence should be dis -\ncontinued slowly, under supervision from your doctor. In contrast, physical \ndependence and withdrawal problems are not associated with CBT.", "source": "shyness_social.pdf"}
{"id": "f5f56355ded7-0", "page_content": "Medications for Social Anxiety and Social Anxiety Disorder\n95U\u00caSome medications (in particular, monoamine oxidase inhibitors) require a \nrestricted diet. CBT does not require any food restrictions.\nU\u00caMany medications must be either used with caution or avoided completely \nduring pregnancy or if you are breastfeeding. CBT can be used safely in \neither of these situations.\nIn deciding whether to try medications, you should consult with your doctor. Keep \nin mind, however, that your doctor\u2019s advice regarding this issue is likely to be in\ufb02uenced \nby his or her own expertise and preferences (for example, family doctors are often much \nless familiar with research on CBT than with medication options). In reality, it\u2019s very \ndif\ufb01cult to predict who is most likely to respond to CBT or vs. medication, vs. a combi -\nnation of these two approaches. We generally recommend that people try CBT initially, \nif it is available, because the bene\ufb01ts tend to be longer lasting than those of medication. \nIn cases where CBT alone is not effective or is only partially effective, the addition of \nmedications can be considered.\nCHOOSING AMONG MEDICATIONS\nIf you decide to try medications, there are two general classes of drugs that have been \nfound to be effective for social anxiety: antidepressant and anti-anxiety medications. \nThere is also evidence that beta-adrenergic blockers (also called \u201cbeta-blockers\u201d) may \nhelp with focused performance fears (for example, fears of public speaking), as well \nas some preliminary research supporting the use of certain anticonvulsant medications \n(these are drugs that are usually used to treat seizures). We will discuss each of these", "source": "shyness_social.pdf"}
{"id": "f5f56355ded7-1", "page_content": "(these are drugs that are usually used to treat seizures). We will discuss each of these \napproaches in this chapter, and we will also review what is known about the use of herbal \nremedies for treating social anxiety.\nWhen selecting among these medications, you and your doctor should take into \naccount the following factors:\nU\u00caResearch \ufb01ndings on available medications . Treatment guidelines recently \npublished by the Canadian Psychiatric Association recommended antide -\npressant treatments as the \ufb01rst medications to try for social anxiety disor -\nder, based on the most recent research (Swinson et al. 2006). In particular, \nvenlafaxine, escitalopram, \ufb02uvoxamine, paroxetine, and sertraline had been \ninvestigated in the largest number of studies at the time the guidelines were \npublished. These medications are discussed later in this chapter.\nU\u00caYour particular social anxiety symptoms . For example, although people \nwith focused performance fears (like public speaking or performing music) \nmay bene\ufb01t from treatment with beta-blockers, people with more general -\nized forms of social anxiety tend not to bene\ufb01t from these medications.", "source": "shyness_social.pdf"}
{"id": "796f0d9a6c3d-0", "page_content": "The Shyness & Social Anxiety Workbook\n96U\u00caSide effect pro\ufb01le of the medication . For instance, if you\u2019re already strug -\ngling with your weight, you might want to choose a medication for which \nweight gain is not a likely side effect.\nU\u00caPrevious response to medications . If you or a family member has previously \nresponded to a particular medication, that drug might be a good option \nfor you to try now. On the other hand, if there is a drug that didn\u2019t work \nfor you in the past (despite a long enough trial at an adequate dosage), this \nmight be a time to try something new.\nU\u00caAdditional psychological disorders that are present . For example, if you \nare experiencing depression, it might make more sense to try an antidepres -\nsant than an anti-anxiety drug. The antidepressant would likely lead to an \nimprovement in both problems.\nU\u00caCost . Older medications tend to be less expensive than newer medications, \noften because older drugs are available in generic forms.\nU\u00caInteractions with other medications and herbal remedies.  If you are already \ntaking certain medications or herbal products, you should choose a drug \nthat will not interact with the products you are already taking.\nU\u00caInteractions with certain foods . Medications such as phenelzine can be dan -\ngerous if taken with certain foods (those containing tyramine, such as aged \ncheese and draft beer). Other medications may also interact with foods. \nFor example, grapefruit juice appears to decrease the metabolism of certain \nselective serotonin reuptake inhibitors (such as sertraline and \ufb02uvoxamine), \nincreasing the likelihood that they will accumulate in the body.", "source": "shyness_social.pdf"}
{"id": "796f0d9a6c3d-1", "page_content": "increasing the likelihood that they will accumulate in the body.\nU\u00caInteractions with medical conditions . If you have a particular medical con -\ndition (for example, high blood pressure), you should choose a drug that will \nnot worsen the symptoms of your illness.\nU\u00caSubstance-use issues . If you enjoy drinking alcohol or if you use other \ndrugs, you should choose a medication that is unlikely to interact with these \nsubstances.\nU\u00caDiscontinuation issues . Medications that leave the body quickly (in other \nwords, those with a short half-life) are more likely to cause withdrawal \nsymptoms and are often harder to discontinue. Therefore, drugs with a \nlonger half-life are usually easier to discontinue. If you and/or your doctor \nare concerned about your ability to discontinue a medication, this should be \nfactored into your decision regarding which drug to take. (The term half-life  \nrefers to the time that it takes for half of the amount of drug in your body", "source": "shyness_social.pdf"}
{"id": "1d2645b00bb5-0", "page_content": "Medications for Social Anxiety and Social Anxiety Disorder\n97to be metabolized or broken down. For example, a drug with a  half-life of \ntwelve hours would be 50 percent broken down in twelve hours and 75 \npercent broken down after another twelve hours. Drugs with a longer half-\nlife are broken down more slowly, giving the body time to adjust to stopping \nthe drug).\nSTAGES IN MEDICATION TREATMENT\nTreatment with medication involves the following \ufb01ve different stages:\n1. The \ufb01rst stage is the assessment . During this phase, your doctor will ask you the \nnecessary questions to help choose the best medication for your needs.\n2. The second stage is initiation of the drug . In most cases, medications are started \nat relatively low dosages to give your body a chance to adapt gradually to \nthe new drug.\n3. The third stage is dose escalation . During this stage of treatment, the dosage \nis gradually increased until the individual\u2019s symptoms start to improve. The \ngoal of dose escalation is to \ufb01nd the lowest dosage that is effective for a \nparticular person. Throughout the process, care is taken to minimize any \nside effects that may be present.\n4. The fourth stage is called maintenance . During maintenance, the individual \ncontinues to take the medication for an extended period of time. For anti   \ndepressants, it is usually recommended that treatment continue for at \nleast a year, minimizing the chances of symptoms returning following \ndiscontinuation.\n5. The \ufb01fth and \ufb01nal stage of medication treatment is discontinuation . Some time \nafter a person has improved on a medication, the individual may be encour -\naged to decrease the amount of the medication to assess whether he or she", "source": "shyness_social.pdf"}
{"id": "1d2645b00bb5-1", "page_content": "aged to decrease the amount of the medication to assess whether he or she \nis ready either to lower the dosage or to stop the medication completely. If a \nperson is also receiving CBT, it may be helpful to have regular CBT sessions \nduring the discontinuation phase. In some cases, your doctor may recom -\nmend that you continue to take a medication that is working for you.\nTREATMENT WITH ANTIDEPRESSANTS\nAntidepressants are the most frequently recommended medications for social anxiety. \nThese drugs are called \u201cantidepressants\u201d because they were initially marketed for treating", "source": "shyness_social.pdf"}
{"id": "873a3ab90ea7-0", "page_content": "The Shyness & Social Anxiety Workbook\n98depression. However, don\u2019t be fooled by their name. These drugs are useful for a wide \nrange of psychological problems, including social anxiety disorder. In fact, they appear to \nwork for this problem regardless of whether an individual is depressed. There are several \nclasses of antidepressant medications that are thought to be useful for treating social \nphobia. Each of these is described in this section. In addition, a table of  recommended \ndosages is included at the end of this section.\nNote that we also indicate which of these drugs is of\ufb01cially approved by the United \nStates Food and Drug Administration (FDA). Although FDA approval typically indicates \nthat a medication is safe and effective when used properly, there are many medications \nthat are safe and effective for social anxiety that are not approved by the FDA or regula -\ntory bodies in other countries. This is because it is very expensive and time consuming \nfor pharmaceutical companies to obtain of\ufb01cial FDA indications for their products, and \nthey therefore tend to limit the number of problems for which they apply for approval.\nSelective Serotonin Reuptake Inhibitors (SSRIs)\nSSRIs are often the \ufb01rst choice for treating social phobia. In fact, the SSRI paroxetine \n(Paxil) was the \ufb01rst drug to receive an FDA indication for treatment of social anxiety \ndisorder. Paroxetine is also available in a continuous release formula, marketed under \nthe name Paxil CR. Another SSRI that is FDA approved is sertraline (Zoloft). Although \nonly two SSRIs are of\ufb01cially approved for treating social anxiety disorder, there is no \nevidence that either of these medications works any better or worse than most other", "source": "shyness_social.pdf"}
{"id": "873a3ab90ea7-1", "page_content": "evidence that either of these medications works any better or worse than most other \nSSRIs for this problem. In practice, any of the SSRIs can be used to treat problems with \nsocial anxiety. Other SSRIs that have been found to be effective for social anxiety disor -\nder include \ufb02uvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro in the \nUnited States, Cipralex in Canada). Fluoxetine (Prozac) has been found to be effective \nin some studies, but not others (Hedges et al. 2007; Swinson et al. 2006).\nAlthough the side effects vary slightly across the SSRIs, some of the most common \nones include nausea, diarrhea, headache, sweating, increased anxiety, tremor, sexual dys -\nfunction, weight gain, dry mouth, palpitations, chest pain, dizziness, twitching, constipa -\ntion, increased appetite, fatigue, thirst, and insomnia. Don\u2019t be discouraged by the long \nlist of side effects. Most people experience only a very small number of these, and some \nindividuals experience no side effects at all. Side effects are generally quite manageable. \nThey tend to be worse during the \ufb01rst few weeks of treatment and can be managed by \nkeeping the dosage low until the person becomes used to the medication. Certain side \neffects (for example, medication-related weight gain and sexual dysfunction) tend not to \ndecrease over time, unless the drug is stopped or the dosage is decreased.\nSSRIs typically take two to four weeks before they start working. They are believed \nto work by altering serotonin levels in the brain. Serotonin is an example of a neurotransmitter , \nwhich is a chemical involved in the transmission of information from one brain cell to the", "source": "shyness_social.pdf"}
{"id": "8c0b339512f7-0", "page_content": "Medications for Social Anxiety and Social Anxiety Disorder\n99next. Serotonin is thought to be involved in the regulation of emotion and other aspects \nof psychological functioning.\nMost SSRIs are relatively easy to discontinue, although paroxetine is more likely \nthan the others to cause withdrawal symptoms during discontinuation because it is \nmetabolized more quickly by the body. Therefore, paroxetine should be stopped more \ngradually than the other SSRIs. Common withdrawal symptoms during discontinuation \nof paroxetine include sleep disturbances, agitation, tremor, anxiety, nausea, diarrhea, dry \nmouth, vomiting, sexual disturbances, and sweating.\nSelective Serotonin and Norepinephrine Reuptake \nInhibitors (SNRIs)\nVenlafaxine XR (Effexor XR) is currently the only available SNRI that has been \nfound in large studies to be effective for treating social anxiety disorder\u2014in fact, it is \napproved by the FDA for this purpose (the \u201cXR\u201d stands for \u201cextended release\u201d). Unlike \nthe SSRIs, venlafaxine acts both on the serotonin and norepinephrine neurotransmitter \nsystems, both of which appear to be related to problems with anxiety and depression. \nA number of well-controlled studies suggest that venlafaxine is useful for treating social \nphobia (Swinson et al. 2006), although, like the SSRIs, it takes several weeks to have \nan effect. The most commonly reported side effects of venlafaxine include sweating, \nnausea, constipation, loss of appetite, vomiting, sleepiness, dry mouth, dizziness, ner -\nvousness, increased anxiety, and sexual disturbances. When discontinued too quickly, \nthe most common withdrawal symptoms include: sleep disturbances, dizziness, nervous -", "source": "shyness_social.pdf"}
{"id": "8c0b339512f7-1", "page_content": "the most common withdrawal symptoms include: sleep disturbances, dizziness, nervous -\nness, dry mouth, anxiety, nausea, headache, sweating, and sexual problems. Duloxetine \n(Cymbalta) is another recently introduced SNRI that has been shown to be useful for \ndepression and some forms of anxiety. However, with the exception of published case \nstudies (Crippa et al. 2007), this drug has not yet been studied for social anxiety, and it \nis too early to recommend it for this problem.\nNoradrenergic/Speci\ufb01c Serotonergic Antidepressants \n(NaSSAs)\nCurrently, the only NaSSA available is a drug called mirtazapine (Remeron). Like \nthe SNRIs, mirtazapine works by affecting levels of both norepinephrine and sero -\ntonin. This drug is newer than the other antidepressants discussed so far. Nevertheless, \nsome initial studies suggest that mirtazapine is an effective treatment for social anxiety \ndisorder (Muehlbacher et al. 2005; Van Veen, Van Vliet, and Westenberg 2002). The \nmost common side effects of mirtazapine include sleepiness, weight gain, dry mouth, \n constipation, and blurred vision.", "source": "shyness_social.pdf"}
{"id": "28e7e9d1c50f-0", "page_content": "The Shyness & Social Anxiety Workbook\n100Monoamine Oxidase Inhibitors (MAOIs)\nMAOIs affect three neurotransmitter systems in the brain: serotonin, norepineph -\nrine, and dopamine. The most studied MAOI for treating social phobia is phenelzine \n(Nardil). This drug has consistently been found to alleviate the symptoms of social \nphobia (Swinson et al. 2006). Like the other antidepressants, phenelzine takes several \nweeks to have a therapeutic effect.\nDespite their effectiveness, MAOIs are rarely used in clinical practice because of \nnecessary dietary restrictions and because the side effects tend to be worse than those \nfrom other medications. When taking MAOIs, you must avoid foods containing a sub -\nstance called tyramine. These include aged cheeses, meat extracts, overripe bananas, \nsausage, tofu, soy sauce, draft beer, and many other foods. MAOIs are also dangerous \nwhen combined with certain other medications, including SSRIs. The most commonly \nreported side effects of MAOIs include dizziness, headache, drowsiness, sleep distur -\nbances, fatigue, weakness, tremors, twitching, constipation, dry mouth, weight gain, low \nblood pressure, and sexual disturbances.\nReversible Inhibitors of Monoamine Oxidase (RIMAs)\nReversible inhibitors of monoamine oxidase are a type of MAOI that tend to have \nfewer side effects than traditional MAOIs. In addition, they are less likely than traditional \nMAOIs to interact with other medications and with foods containing tyramine. The only \nRIMA that is available is moclobemide (Manerix in Canada, Aurorix in several other", "source": "shyness_social.pdf"}
{"id": "28e7e9d1c50f-1", "page_content": "countries), though this drug is not currently marketed in the United States. Findings \nfrom studies on moclobemide for social anxiety disorder have been mixed. Early studies \nfound that this medication was helpful for treating social anxiety, whereas more recent \nstudies have found only modest effects. In some studies, moclobemide was no better \nthan placebo (Swinson et al. 2006).\nThe most commonly reported side effects for people taking moclobemide include \nfatigue, constipation, low blood pressure, decreased sex drive, dry mouth, dif\ufb01culties \nejaculating, insomnia, vertigo, and headache. Like the other antidepressants,  moclobemide \ntakes several weeks to have a therapeutic effect.", "source": "shyness_social.pdf"}
{"id": "5f0abf8f9590-0", "page_content": "Medications for Social Anxiety and Social Anxiety Disorder\n101Dose Ranges for Antidepressants in the Treatment of Social Phobia\nGeneric Name    Brand Name   Therapeutic Dose Range (mg)*\nSSRIs\ncitalopram    Celexa   10\u201360\nescitalopram    Lexapro/Cipralex   10\u201320\n\ufb02uoxetine    Prozac   10\u201380\n\ufb02uvoxamine    Luvox   50\u2013300\nparoxetine    Paxil  10\u201360\nparoxetine CR    Paxil CR   12.5\u201375\nsertraline    Zoloft   50\u2013200\nOther Antidepressants\nmirtazapine    Remeron   15\u201360\nmoclobemide    Manerix/Aurorix   300\u2013600\nphenelzine    Nardil  45\u201390\nvenlafaxine XR    Effexor XR   75\u2013375\n*Dosages are based, in part, on recommendations by Bezchlibnyk-Butler, Jeffries, and Virani 2007.\nTREATMENT WITH ANTI-ANXIETY MEDICATIONS\nThe most frequently prescribed anti-anxiety medications are the benzodiazepines. These \nare sedatives that include drugs such as clonazepam (Klonapin in the USA; Rivotril \nin Canada), alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). To date, \nonly clonazepam and alprazolam have been investigated in controlled studies for the \ntreatment of social anxiety disorder (Swinson et al. 2006). Although neither is of\ufb01cially", "source": "shyness_social.pdf"}
{"id": "5f0abf8f9590-1", "page_content": "approved by the FDA for treating social anxiety, both of these medications have been \nfound to be useful for this problem. The typical starting dose for alprazolam and clon -\nazepam is .5 mg per day, with a maximum daily dose of 1.5 to 3 mg for alprazolam and \n4 mg for clonazepam (Swinson et al. 2006).\nWhen taken on a regular basis, these medications tend to be effective for treat -\ning social anxiety. The most common side effects include drowsiness,  lightheadedness, \ndepression, headache, confusion, dizziness, unsteadiness, insomnia, and nervousness.", "source": "shyness_social.pdf"}
{"id": "3e34cdcb905d-0", "page_content": "The Shyness & Social Anxiety Workbook\n102These drugs may affect a person\u2019s ability to drive safely and they tend to interact \nstrongly with alcohol. In addition, they should be used with caution by older people \nbecause higher dosages have been associated with a greater likelihood of falling.\nThere are several advantages to taking benzodiazepines compared with antidepres -\nsant medications. First, they work very quickly (within a half hour) and therefore can \nbe used on an \u201cas needed\u201d basis to deal with particularly stressful situations. They also \nmay be used during the \ufb01rst few weeks of antidepressant treatment, while the indi -\nvidual waits for the antidepressant to take effect. In addition, the side effect pro\ufb01le of \n benzodiazepines is quite different from that of antidepressants, and these drugs may be \nmore easily tolerated by some people.\nDespite these bene\ufb01ts, benzodiazepines have fallen out of favor in recent years, \nmostly because they can be dif\ufb01cult to discontinue. Stopping these drugs can cause \ntemporary (but sometimes intense) feelings of anxiety, arousal, and insomnia. In rare \ncases, abrupt discontinuation can cause seizures. Given that discontinuation from these \nmedications can cause intense anxiety, it is not surprising that some individuals have \ndif\ufb01culty stopping these drugs. The symptoms of withdrawal can be minimized by dis -\ncontinuing these drugs very gradually. Benzodiazepines are a potentially effective option \nfor treating social anxiety, particularly over brief periods. However, they are typically \nnot recommended as a \ufb01rst-line treatment (Swinson et al. 2006).\nTREATMENT WITH BETA-ADRENERGIC BLOCKERS", "source": "shyness_social.pdf"}
{"id": "3e34cdcb905d-1", "page_content": "TREATMENT WITH BETA-ADRENERGIC BLOCKERS\nBeta-blockers are normally used for treating high blood pressure. In addition, they are \neffective for decreasing some of the physical symptoms of fear such as palpitations and \nshakiness. A number of early studies suggest that beta-blockers are useful for managing \nintense fear in certain performance situations (Hartley et al. 1983; James, Burgoyne, and \nSavage 1983). In particular, they are often used by actors, musicians, and other perform -\ners to manage stage fright. However, beta-blockers are ineffective for treating more \ngeneralized forms of social anxiety and shyness. The most commonly used beta-blocker \nfor treating performance fears is propanolol (Inderal). This medication is normally taken \nin a single dose of 5 to 10 mg, about twenty to thirty minutes before a performance.\nANTICONVULSANTS\nAnticonvulsants are used to treat seizures, as well as pain, anxiety, and certain mood \nproblems. Recently, there have been a number of preliminary studies \ufb01nding that certain \nanticonvulsants such as gabapentin (Neurontin), pregabalin (Lyrica), and topiramate \n(Topamax) may be useful for treating social anxiety disorder (Swinson et al. 2006). At \nthis point, however, it is too soon to recommend these treatments for social anxiety. \nAdditional research is needed.", "source": "shyness_social.pdf"}
{"id": "fcbd87bf9793-0", "page_content": "Medications for Social Anxiety and Social Anxiety Disorder\n103NATURAL AND HERBAL REMEDIES FOR  \nSOCIAL ANXIETY\nIn recent years, herbal preparations have become popular for treating a wide range of \nhealth problems. For the treatment of anxiety and related problems, commonly used \nherbal preparations include St.-John\u2019s-wort, kava kava, inositol, Rescue Remedy, and \nvarious other products. Generally, there have been very few studies on these products \nin people with anxiety-based problems, and we are aware of only one study that has \nspeci\ufb01cally tested the effects of an herbal remedy for treating social anxiety disorder \n(Kobak et al. 2005). In this study, 600 to 1800 mg per day of St.-John\u2019s-wort (also known \nas hypericum) was compared to an inactive placebo in forty people with social anxiety \ndisorder. No differences were found in the effectiveness of St.-John\u2019s-wort vs. placebo, \ndespite the fact that some studies have found St.-John\u2019s-wort to be an effective treatment \nfor depression.\nIn addition to the lack of studies on the effectiveness  of herbal treatments, very little is \nknown about the safety  of many of these remedies or the extent to which they interact \nwith conventional medications. Be sure to tell your doctor if you are taking any herbal \nproducts, just in case there are any known interactions with medications you may also \nbe taking.\nAlthough little is known about the effects of herbal treatments on social anxiety, \nthere are a few studies on the use of herbal products for other anxiety problems (Connor \nand Vaishnavi, in press). Still, more studies are currently under way. In the coming years, \nadditional information regarding the safety, interactions, and effectiveness of these", "source": "shyness_social.pdf"}
{"id": "fcbd87bf9793-1", "page_content": "additional information regarding the safety, interactions, and effectiveness of these \n treatments will be available.\nCOMBINING MEDICATIONS\nYour doctor may recommend combining several medications for treating your social \nanxiety. In most cases, there is very little research on the bene\ufb01ts of combining differ -\nent medications. However, one combination that has been studied for the treatment of \nanxiety is the combination of an antidepressant (for example, paroxetine) with a benzodi -\nazepine (for example, clonazepam). Ideally, both drugs are started at the same time. The \nbenzodiazepine helps to keep the anxiety under control during the \ufb01rst few weeks while \nthe person waits for the antidepressant to start working. Then, once the  antidepressant \nkicks in, the benzodiazepine is discontinued gradually. \nA limited number of studies have investigated whether it is useful to combine an \nSSRI with a benzodiazepine. Whereas some studies of anxiety problems other than \nsocial phobia suggest that this combination is useful for reducing anxiety symptoms \nmore quickly than an SSRI alone (Pollack et al. 2003), a study of people suffering from \nsocial phobia did not \ufb01nd any added bene\ufb01t of combining medications on the rate of \nrecovery (Seedat and Stein 2004).", "source": "shyness_social.pdf"}
{"id": "1ba869b98883-0", "page_content": "The Shyness & Social Anxiety Workbook\n104COMBINING MEDICATION WITH \nPSYCHOLOGICAL TREATMENTS\nStudies comparing medications to CBT have generally found both approaches to be very \neffective for reducing anxiety. In addition, a number of researchers have begun to study \nthe bene\ufb01ts of combining CBT and medications (Antony and Rowa 2008). Overall, there \ndo not appear to be any consistent bene\ufb01ts of combining these treatments. That is, \nmedication, CBT, and a combination of these approaches all tend to be about equally \neffective on average, based on the available evidence (for instance, Davidson et al. 2004). \nHowever, that doesn\u2019t mean that one approach or another is not likely to be more effec -\ntive for any one person (including you). In other words, it is often the case that some \npeople do best with CBT, some do best with medication, and some do best with a com -\nbined treatment. If you decide to try combining CBT with medication, it is helpful if \nboth treatments are delivered by the same person, or if the professionals providing you \nwith CBT and medication are in contact with one another. Treatment is most likely to \nbe helpful when multiple treatments are delivered in a coordinated fashion.\nCOMMON QUESTIONS ABOUT MEDICATION\nQuestion:  Is taking medication a sign of weakness?\nAnswer:   Taking medication for social phobia is no more a sign of weakness than \ntaking medication for any other problem, such as physical illnesses like \nhigh blood pressure.\nQuestion:  What level of improvement can I expect?\nAnswer:   A small percentage of people obtain no bene\ufb01t at all from medications \nfor social phobia. Another small group of people obtain almost com -", "source": "shyness_social.pdf"}
{"id": "1ba869b98883-1", "page_content": "for social phobia. Another small group of people obtain almost com -\nplete improvement. However, most people with social phobia experi -\nence moderate improvements with medications. They tend to feel less \nanxious overall and are more comfortable in a broader range of situa -\ntions. However, there may still be areas in which the social anxiety is a \nproblem for them.\nQuestion:  Are medications for social anxiety dangerous?\nAnswer:   When taken as prescribed, medications for social phobia are gener -\nally safe. When side effects cause problems, as a rule they are easy to \nmanage by decreasing the dosage or switching to a different drug.", "source": "shyness_social.pdf"}
{"id": "19a3e36bc58f-0", "page_content": "Medications for Social Anxiety and Social Anxiety Disorder\n105Question:  Is it dangerous for me to stop taking my medication?\nAnswer:   Medications should always be stopped gradually and in close consul -\ntation with your doctor. If done properly, discontinuation is generally \nsafe.\nQuestion:  What happens if my medication doesn\u2019t work for me?\nAnswer:   If your medication doesn\u2019t work, it is important to \ufb01rst make sure you \nhave been taking it for a long enough time and at an adequate dose. If \nyour medication still is not effective despite an appropriate duration and \ndosage, you may still bene\ufb01t from trying a different medication or from \nreceiving CBT.\nQuestion:   How long should I try a medication before assuming that it isn\u2019t going \nto work?\nAnswer:   Most antidepressants will start to have an effect within four to six weeks, \nif not earlier. If you haven\u2019t experienced any bene\ufb01t after eight weeks \nat a high enough dosage, it may be worth discussing the possibility of \ntrying a different treatment with your doctor.\nQuestion:   If I go off my medication and my anxiety returns, am I likely to bene\ufb01t \nagain if I resume taking the same medication?\nAnswer:   Often, when a previously effective medication is tried for a second time \n(following a break), it will work again. However, sometimes a particular \nmedication is less effective the second time, in which case a different \nmedication may be prescribed.\nIn summary, medications can be an effective method of managing severe social \nanxiety. Certain anti-anxiety medications (for example, clonazepam) and a number of \ndifferent antidepressants (for instance, paroxetine, venlafaxine) have consistently been", "source": "shyness_social.pdf"}
{"id": "19a3e36bc58f-1", "page_content": "shown to help reduce symptoms of social anxiety. If you decide that you would like to \ntry medication, a \ufb01rst step is to contact your family doctor or psychiatrist. Your doctor \nwill be able to recommend a speci\ufb01c medication that is likely to work for you.", "source": "shyness_social.pdf"}
{"id": "c8b24f84701b-0", "page_content": "CHAPTER 6\nChanging Your Anxious \nThoughts and Expectations\nThe word cognition  refers to the ways in which we process information, including experi -\nences such as thought, perception, interpretation, attention, memory, and knowledge. \nThe word cognitive  is simply the adjectival form of the term cognition. For example, \ncognitive science is the science concerned with the ways in which we think. Cognitive \ntherapy  is a type of psychotherapy that is designed to alter negative and unrealistic beliefs, \nthoughts, and interpretations.\nThis chapter provides an overview of strategies that have been shown to be useful for \ndecreasing social anxiety by changing negative or unrealistic patterns of thinking. Many \nof the cognitive techniques and principles discussed in this book have been presented \nand expanded upon elsewhere by authors such as Aaron T. Beck (Beck, Emery, and \nGreenberg 1985), David Burns (1999), David M. Clark (Clark and Wells 1995), Richard \nHeimberg (Heimberg and Becker 2002), Christine Padesky (Greenberger and Padesky \n1995), and others. Over the years, strategies similar to those discussed in this chapter \nhave been adopted by the majority of therapists who practice cognitive therapy.\nTHE ORIGINS OF COGNITIVE THERAPY\nCognitive therapy was proposed in the 1960s and 1970s as an alternative to traditional \npsychodynamic psychotherapies , which were the most prevalent forms of therapy at the time. \nThe original (and most in\ufb02uential), form of psychodynamic psychotherapy is psychoanaly -\nsis, which Sigmund Freud developed in the early 1900s. Psychodynamic psychotherapies,", "source": "shyness_social.pdf"}
{"id": "8ee430af8410-0", "page_content": "The Shyness & Social Anxiety Workbook\n108including psychoanalysis, are concerned with helping individuals understand deep-rooted \nunconscious con\ufb02icts that are presumed to cause or contribute to their psychological \nproblems. For example, Freud proposed that depression can occur as a response to \nhaving unconscious aggressive thoughts or feelings toward a loved one. Because such \nfeelings are viewed as unacceptable by the individual, he or she is very motivated to \nkeep such thoughts and feelings outside of conscious awareness. According to Freud, \nrather than allowing the aggressive thoughts to surface, the individual may turn those \nangry feelings inward, leading to feelings of self-hatred and worthlessness, which are \noften features of depression.\nThere are many newer forms of psychodynamic therapy (most psychodynamic psy -\nchotherapists no longer accept all of Freud\u2019s ideas), though the focus of these treatments \noften remains on recounting early childhood experiences, interpreting unconscious expe -\nrience (such as dreams), and helping individuals to understand the unconscious motiva -\ntions for their behavior. Although psychodynamic psychotherapies remain popular, they \nhave gradually lost ground to other forms of therapy, including cognitive and behavioral \ntherapies. Some reasons for the decline of psychodynamic psychotherapies include the \nrelative lack of research supporting many of the underlying theoretical assumptions, as \nwell as a lack of research demonstrating the effectiveness of this form of treatment for \nmany speci\ufb01c problems, including social anxiety.\nDespite these criticisms, psychoanalysis and the psychodynamic psychotherapies \nhave made considerable contributions to the understanding and treatment of psycho -\nlogical problems. For example, these were the \ufb01rst treatments based on the assumption \nthat simply talking to another person can lead to psychological changes. In addition,", "source": "shyness_social.pdf"}
{"id": "8ee430af8410-1", "page_content": "that simply talking to another person can lead to psychological changes. In addition, \nthese treatments highlighted the importance of nonconscious information processing. \nAlthough there is little evidence to prove the existence of many of the unconscious \nmotivations proposed by Freud, there is evidence that suggests people are frequently \nunaware of the perceptions and interpretations that contribute to their understanding \nof their environment. Finally, although many speci\ufb01c aspects of his theory were prob -\nably misguided, Freud highlighted the importance of early experience in determining \n psychological functioning later in life.\nThe Birth of Cognitive Therapy\nIn the 1960s and 1970s, a number of psychologists and psychiatrists, disenchanted \nwith psychodynamic psychotherapies, began to explore other ways of helping their \npatients and clients. Working independently, psychiatrist Aaron Beck (1963; 1964; 1967; \n1976) and psychologists Albert Ellis (1962; 1989) and Donald Meichenbaum (1977) each \ndeveloped new forms of therapy based on the premise that people\u2019s dif\ufb01culties with \ndepression, anxiety, anger, and related problems stem from the ways in which they think \nabout themselves, their environment, and the future.\nFor example, fear was assumed to stem from a belief that a particular situation was \nthreatening or dangerous. Beck, Ellis, and Meichenbaum each developed treatments", "source": "shyness_social.pdf"}
{"id": "3f7b5a16812e-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n109designed to help individuals recognize how their beliefs and assumptions contribute to \ntheir negative emotions, and to overcome psychological suffering by changing these neg -\native thoughts. Ellis called his form of treatment  rational emotive therapy  and later renamed \nit rational emotive behavior therapy  (REBT, 1993). Meichenbaum referred to his form of treat -\nment as cognitive-behavior modi\ufb01cation (CBM). It was Aaron Beck, however, who \ufb01rst \nused the term cognitive therapy  to describe his treatment. Each of these three new treat -\nments was developed at about the same time, and they were quite similar with respect \nto their underlying assumptions and some of the treatment strategies used.\nOver the years, Beck\u2019s form of treatment has become more popular and prominent \nthan either Ellis\u2019s or Meichenbaum\u2019s approaches. Furthermore, Beck\u2019s cognitive therapy \nhas been subjected to more rigorous study than either REBT or CBM for the treatment \nof social anxiety. Therefore, the methods discussed in this chapter are based on those \nproposed by Beck and his collaborators, as well as others who adapted and expanded \nupon Beck\u2019s methods for treating social anxiety and related problems.\nASSUMPTIONS OF COGNITIVE THERAPY  \nFOR SOCIAL ANXIETY\nHere are some of the basic assumptions of cognitive therapy, particularly as related to \nthe treatment of shyness, social anxiety, and performance fears.\n1. Negative emotions are caused by negative interpretations and beliefs. People \nwho interpret a given situation in different ways are likely to experience dif -\nferent emotions. For example, imagine that a friend of yours has cancelled \na dinner date at the last minute without providing a reason. Below is a list \nof possible emotional reactions you might have depending on your beliefs", "source": "shyness_social.pdf"}
{"id": "3f7b5a16812e-1", "page_content": "of possible emotional reactions you might have depending on your beliefs \nand interpretations.\nSituation : Friend cancels dinner date at the last minute and gives no reason\nInterpretation Emotion\n\u201cMy friend has been hurt or is ill.\u201d Anxiety or worry\n\u201cMy friend isn\u2019t treating me with the respect I deserve.\u201d Anger\n\u201cMy friend doesn\u2019t care about me.\u201d Sadness\n\u201cThank goodness the dinner has been cancelled; I am \nalways so nervous when I have to eat with others.\u201dRelief\n\u201cI guess something else came up. Everyone changes  \nplans from time to time, including me.\u201dNeutral", "source": "shyness_social.pdf"}
{"id": "4a886aa07fe3-0", "page_content": "The Shyness & Social Anxiety Workbook\n1102. Anxiety and fear result when a person interprets a situation as threatening \nor dangerous. Although fearful predictions and interpretations are sometimes \naccurate, they are often exaggerated or inaccurate. Chapter 1 provided a list of \nthoughts and assumptions that can contribute to social anxiety. These include \nbeliefs about one\u2019s performance (such as, \u201cPeople will think that I am an idiot\u201d), \nas well as beliefs about the anxiety itself (for instance, \u201cIt\u2019s important for me \nnot to appear anxious in front of other people\u201d). Beliefs such as these help to \nmaintain a person\u2019s anxiety in social and performance situations.\n3. You are the expert regarding your own thoughts and feelings. Unlike some \nother forms of therapy, which assume that the therapist is the expert, cogni -\ntive therapy assumes that the patient and therapist have unique areas of exper -\ntise, and the best way to work on a problem is to take advantage of the skills \nand expertise that each brings to the therapeutic situation. The therapist is \nassumed to be an expert on the principles and methods of cognitive therapy. \nThe patient is assumed to be an expert regarding his or her own experi -\nences, assumptions, and beliefs. In most cases, the therapist and patient decide \ntogether whether a particular belief is exaggerated or unrealistic, and together \nthey generate strategies for changing negative patterns of thinking.\n4. The goal of cognitive therapy is to be able to think more realistically  rather \nthan simply to think positively . There are occasions where your anxious beliefs \nare realistic and are quite consistent with the actual threat in a given situa -\ntion. In these cases, anxiety may be a good thing because it helps you stay \non guard and protect yourself from possible danger. For instance, being a bit", "source": "shyness_social.pdf"}
{"id": "4a886aa07fe3-1", "page_content": "on guard and protect yourself from possible danger. For instance, being a bit \nnervous while interacting with an authority \ufb01gure (for example, your boss, a \npolice of\ufb01cer) may protect you from seeming overly con\ufb01dent, demanding, \nor aggressive. Cognitive therapy focuses on situations where your beliefs, \npredictions, and interpretations are exaggerated when compared with the \nactual level of danger in the situation.\n5. People naturally tend to seek out and pay attention to information that con -\n\ufb01rms their beliefs. In the case of social anxiety, people pay more atten -\ntion and give more weight to evidence that others are judging them nega -\ntively (such as a history of being teased in high school) than to evidence \nthat contradicts the anxious beliefs (for instance, a history of very positive \nperformance appraisals at work). Cognitive therapy aims to help people to \n consider all the evidence before making any assumptions.\nTYPES OF ANXIOUS THINKING\nAnxious thinking begins and persists when people make incorrect assumptions about \nwhat is likely to happen in a given situation, about the quality of their own performance,", "source": "shyness_social.pdf"}
{"id": "bf88131e8e1f-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n111and about what other people are thinking of them. This section includes descriptions \nof some of the most common styles of thinking that often seem to play a role in social \nand performance anxiety. Note that there are additional examples of negative and exag -\ngerated thinking that other authors have highlighted (see, for example, Burns 1999) that \nwe have chosen not to include in this section. In most cases, these were omitted either \nbecause they were not especially relevant to social anxiety or because they were very \nsimilar and overlapped considerably with those examples that we have included. In fact, \neven the various thinking styles on this list overlap to some extent. As you may notice, a \nparticular anxious thought (something like, \u201cOther people will think that I am boring\u201d) \nmay easily \ufb01t into more than one category (probability overestimation, mind reading).\nProbability Overestimations\nA probability overestimation is a prediction that a person believes is likely to come true, \neven though the actual likelihood is relatively low. For example, someone who is fearful of \ngiving presentations might predict that the next presentation is likely to go poorly, even \nthough her presentations usually go well. Similarly, a person who is nervous about dating \nmight assume that other people will \ufb01nd him unattractive, even though many people \nhave found him to be attractive in the past. If your thoughts are similar to those listed \nbelow, you may have a tendency to overestimate the likelihood of negative events.\nExamples of Probability Overestimations\nU\u00caI will be overwhelmed with panic.\nU\u00caEveryone at the party will think I\u2019m stupid.\nU\u00caMy presentation will be a disaster.\nU\u00caI will never be in an intimate relationship again.", "source": "shyness_social.pdf"}
{"id": "bf88131e8e1f-1", "page_content": "U\u00caI will never be in an intimate relationship again.\nU\u00caI will have nothing to say if I phone my cousin.\nU\u00caI will lose my job if I make a mistake.\nU\u00caIf I go out, everyone will stare at me.\nCan you think of recent instances when you assumed that things were going to work \nout badly, without any evidence for that assumption? If so, list your own examples of \nprobability overestimations below:", "source": "shyness_social.pdf"}
{"id": "2137a48002ae-0", "page_content": "The Shyness & Social Anxiety Workbook\n112Mind Reading\nMind reading  is actually just an example of a probability overestimation. It involves \nmaking negative assumptions about what other people are thinking, particularly what \nthey might be thinking about you. If social anxiety is a problem for you, it is likely \nthat you assume that others think negatively about you. Although it is true that people \nsometimes make negative judgments about others, the chances are that this occurs much \nless often than you think. In many cases, your assumptions about what others are think -\ning are probably exaggerated or even completely untrue. Each of the following kinds of \nthoughts represents mind reading:\nExamples of Mind Reading\nU\u00caPeople \ufb01nd me boring.\nU\u00caMy boss will think I\u2019m an idiot if he sees my hands shaking.\nU\u00caWhen people look at me, they are thinking I am strange or weird.\nU\u00caMost people see anxiety as a sign of weakness.\nU\u00caMy friends think I am awkward or stupid when I lose my train of thought.\nU\u00caPeople always know when I am feeling anxious.\nCan you think of recent examples of times when you have made assumptions about \nwhat other people are thinking about you? If so, list your own examples of mind reading \nbelow:\nPersonalization\nPersonalization  is the tendency to take more responsibility for a negative situation than \nyou should, rather than acknowledging all of the different factors that may have contrib -\nuted to the situation. Here are some examples of personalization, followed by examples \nof other factors that in reality may have contributed to the situation.", "source": "shyness_social.pdf"}
{"id": "ea0fef5311ab-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n113Examples of Personalization In Reality\nAt a friend\u2019s birthday party, I \nwas talking to another guest \nand we ran out of things to \ntalk about very quickly. I think \nthe conversation ended so fast \nbecause I am so boring and \ncan\u2019t think of things to say.In reality, other factors that may have contrib -\nuted to the situation include (1) the other person \ncouldn\u2019t think of anything to talk about, (2) I had \nnothing in common with the other guest, even \nthough neither of us is actually boring, and (3) it \nis normal for many conversations at parties to end \nfairly quickly. Nobody was at fault.\nThe fact that my boss got \nangry at me for making a \nmistake is proof that I am \nincompetent.In reality, other factors that may have contrib -\nuted to the situation include (1) my boss is always \ngetting angry at people, so I shouldn\u2019t feel singled \nout, (2) my boss\u2019s expectations are too high (I \nknow that not every boss in the world would have \nyelled at me for making a mistake; part of why my \nboss became angry had to do with his own  \nexpectations, rather than me making a mistake), \nand (3) there are many reasons why people make \nmistakes besides incompetence.\nPeople were falling asleep \nduring my presentation, \nproving once again that I am a \nreally boring speaker.In reality, other factors that may have contributed \nto the situation include (1) the topic was somewhat \ndry and would have been dif\ufb01cult for any speaker \nto make exciting, (2) the presentation was late in", "source": "shyness_social.pdf"}
{"id": "ea0fef5311ab-1", "page_content": "to make exciting, (2) the presentation was late in \nthe day, and the audience was feeling tired, and (3) \nit is normal for some people to feel bored at a talk; \nother people probably found it interesting.\nI was in an elevator and a \nwoman was looking at me. She \nwas probably thinking that I \nlooked strange.In reality, other factors that may have contributed \nto the situation include (1) she was staring at me \nbecause she liked the way I look or what I was \nwearing, (2) she was looking in my direction but \nwasn\u2019t really looking at me (maybe she was staring \ninto space or daydreaming), and (3) she noticed \nme but was thinking of other things.\nCan you think of recent examples of times when you engaged in personalization? If so, \nlist your own examples of personalization in the space below:", "source": "shyness_social.pdf"}
{"id": "e3e8274b8293-0", "page_content": "The Shyness & Social Anxiety Workbook\n114\u201cShould\u201d Statements\n\u201cShould\u201d statements  are incorrect or exaggerated assumptions about the way things ought \nto be. Statements that include words like \u201calways,\u201d \u201cnever,\u201d \u201cshould,\u201d and \u201cmust\u201d are \noften \u201cshould\u201d statements. Sometimes, the tendency to use words such as these is a sign \nof having overly rigid and perfectionistic expectations for yourself or for others. Here \nare some examples:\nExamples of \u201cShould\u201d Statements\nU\u00caI should never feel nervous around other people.\nU\u00caI must never let my anxiety show.\nU\u00caI should never make mistakes.\nU\u00caI must never inconvenience other people.\nU\u00caOthers should never think badly about me.\nU\u00caI ought never to do anything to draw attention to myself.\nU\u00caOthers must never tease me or laugh at something that I have done.\nU\u00caI should always be interesting and entertaining to others.\nU\u00caI must do things perfectly so everything is just right.\nIn the space below, list examples from your own life of unreasonable expectations \n(\u201cshoulds\u201d) that you hold for yourself or others:\nCatastrophic Thinking\nCatastrophic thinking  (also known as catastrophizing ) is the tendency to assume that if a \nnegative event were to occur, it would be absolutely terrible and unmanageable. From \ntime to time, we all make mistakes, offend others, or look foolish. One difference \nbetween people who are socially anxious and those who are not particularly anxious is \nhow they deal with these unfortunate social events. People who have very little social \nanxiety are often able to say to themselves, \u201cWho cares what this person thinks? I have", "source": "shyness_social.pdf"}
{"id": "e3e8274b8293-1", "page_content": "the right to make a mistake from time to time.\u201d Or, \u201cI feel sorry that I upset that person,", "source": "shyness_social.pdf"}
{"id": "a0a2f99c24c5-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n115but everyone puts their foot in it at times.\u201d In contrast, people who feel anxious around \nothers are more likely to think, \u201cIt would be a disaster to have others think badly of me.\u201d \nBelow are more examples of catastrophic thinking:\nExamples of Catastrophic Thinking\nU\u00caIt would be terrible if my anxiety showed during my presentation.\nU\u00caI would not be able to handle making a fool of myself.\nU\u00caIt would be terrible to be unable to think of things to say during my date \non Saturday night.\nU\u00caIf someone shows signs of not liking me, it feels like the end of the world.\nU\u00caIt would be terrible to lose my train of thought during a presentation.\nU\u00caIt would be a disaster if I blushed while answering a question in class.\nIn the space below, list examples of times when you have catastrophized or exaggerated \nhow bad a particular outcome would be if it actually were to occur:\nAll-or-Nothing Thinking\nAll-or-nothing thinking (also called black-and-white thinking ) is the tendency to judge any \nperformance that falls short of perfection as being completely unacceptable. People who \nengage in this style of thinking tend to categorize their behavior as being either perfect \nor awful, without acknowledging all of the possibilities that lie between these two \nextremes. As with \u201cshould\u201d statements, all-or-nothing thinking is associated with exces -\nsive perfectionism and a tendency to hold unrealistic standards. Following are several \nexamples of all-or-nothing thinking:\nExamples of All-or-Nothing Thinking\nU\u00caIf I lose my train of thought even once, I will blow the entire presentation.\nU\u00caEven one person thinking I look nervous is too many.", "source": "shyness_social.pdf"}
{"id": "a0a2f99c24c5-1", "page_content": "U\u00caEven one person thinking I look nervous is too many.\nU\u00caIf I don\u2019t get an A on my exam, my teacher will think I am stupid.", "source": "shyness_social.pdf"}
{"id": "29ad9352a88e-0", "page_content": "The Shyness & Social Anxiety Workbook\n116U\u00caIt is unacceptable if my boss makes any negative comments or suggests even \none area for improvement during my annual performance review.\nU\u00caShowing any signs of anxiety is almost as bad as falling completely apart.\nIn the space below, list examples of the times when you engaged in all-or-nothing \nthinking:\nSelective Attention and Memory\nSelective attention is the tendency to pay more attention to certain types of information \nthan to other types. Selective memory is the tendency to remember certain types of informa -\ntion more easily than other types. As discussed earlier, people are more likely to attend \nto and remember information that is consistent with their beliefs. Therefore, people with \nsocial anxiety are more likely than others to remember times when they were criticized \nor teased by another person or when they performed poorly in a social situation. When \nperforming in social situations or interacting with others, individuals with social phobia \nare more likely to notice people who appear to be bored or disapproving. Some other \nexamples of selective memory and attention are provided below:\nExamples of Selective Attention and Memory\nU\u00caIgnoring positive feedback from a teacher or boss (in other words, discount -\ning positive feedback as if it doesn\u2019t matter), yet taking negative feedback \nvery seriously (for example, letting negative feedback ruin your day)\nU\u00caFocusing on the one low grade on your report card and ignoring all the \nhigh grades\nU\u00caRemembering being teased in high school, while forgetting about the good \ntimes spent with friends after school\nU\u00caFocusing on audience members who seem bored during your presentation \nand ignoring those in the crowd who appear to be enjoying your talk\nU\u00caFocusing on the moment during a conversation when you stumbled over", "source": "shyness_social.pdf"}
{"id": "29ad9352a88e-1", "page_content": "U\u00caFocusing on the moment during a conversation when you stumbled over \nyour words and lost your train of thought, while ignoring the fact that the \nrest of the conversation was fairly smooth", "source": "shyness_social.pdf"}
{"id": "28f7336f676b-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n117Can you think of ways in which you selectively pay attention to events or information \nthat con\ufb01rm your anxious beliefs and selectively ignore information that is inconsistent \nwith those beliefs? In the space below, list examples of times when you have engaged in \nselective attention or memory:\nNegative Core Beliefs\nIn addition to paying attention to your negative thinking in particular situations that \ntrigger your anxiety, it may also be useful to become more aware of any deeper, more \ncentral, and long-standing assumptions that contribute to your feelings of anxiety. These \nassumptions are called core beliefs  and they can include negative assumptions that people \nhold about themselves (for example, \u201cI am incompetent\u201d), other people (for instance, \n\u201cOther people cannot be trusted\u201d), and the world (such as, \u201cThe world is a dangerous \nplace\u201d). The more strongly held these core beliefs are, the more dif\ufb01cult they may be \nto change.\nOne technique for uncovering core beliefs involves continually asking about the \nmeaning of each fearful belief you have until the core beliefs underlying your anxious \ninterpretations are revealed. This process is illustrated in the following conversation \nbetween Liam and his therapist:\nLiam:   I am terri\ufb01ed to ask my coworker Cindy out on a date.\nTherapist:   What are you afraid might happen if you ask her out?\nLiam:   Mostly, I\u2019m afraid she will say no.\nTherapist:   Why would that be a problem?\nLiam:   If she rejects me, it will probably mean that she doesn\u2019t \ufb01nd me attractive.\nTherapist:   What would be so bad about that?\nLiam:   It will con\ufb01rm my own belief that I am unattractive.", "source": "shyness_social.pdf"}
{"id": "28f7336f676b-1", "page_content": "Therapist  : What if that\u2019s true?\nLiam:    Well, if I really am unattractive, that means nobody will ever think I\u2019m \nattractive or want to date me. It would mean that I am unlovable.\nTherapist:   What would be bad about being unlovable?", "source": "shyness_social.pdf"}
{"id": "210b8cb98990-0", "page_content": "The Shyness & Social Anxiety Workbook\n118Liam:   If I am unlovable, I am bound to be alone forever.\nTherapist:    So, to summarize, you seem to be saying that (1) if another person turns \ndown your invitation for a date, it means that she \ufb01nds you unattractive, (2) \nif another person \ufb01nds you unattractive, then everyone will \ufb01nd you unat -\ntractive, (3) being turned down for a date means that you are unlovable and \ndestined to be alone forever. Do you think of yourself as unlovable?\nLiam:    I think I do. Part of me knows it isn\u2019t true, but much of the time I just can\u2019t \nshake that belief.\nHOW TO IDENTIFY YOUR ANXIOUS THOUGHTS \nAND PREDICTIONS\nIn chapter 3, we discussed strategies for identifying your anxious thoughts. We suggest \nthat you review the relevant passages in chapter 3 on identifying anxious thoughts before \ntrying to use the techniques discussed in the remainder of this chapter. There is no point \ntrying to change your anxious beliefs unless you are clear about the content of these \nbeliefs. In addition to reviewing the anxious thoughts recorded in chapter 3, identify -\ning your anxious beliefs, predictions, and assumptions should be an ongoing process. \nWhenever you \ufb01nd yourself in an anxiety-provoking situation, try to identify the speci\ufb01c \nthoughts and beliefs that contribute to your discomfort. In most cases, you can identify \nyour anxious predictions and assumptions by asking yourself a series of questions such \nas the following:\nU\u00caWhat am I afraid will happen in this situation?\nU\u00caWhat do I fear that the other person will think about me?", "source": "shyness_social.pdf"}
{"id": "210b8cb98990-1", "page_content": "U\u00caWhat do I fear that the other person will think about me?\nU\u00caWhat will happen if my anxious thoughts are true?\nSometimes it may be dif\ufb01cult to pinpoint your fearful thoughts. Chances are that \nsocial anxiety has been a part of your life for so long that your negative thoughts are \nwell-rehearsed, very quick, and almost automatic (like habits). Also, the fact that you \nprobably avoid the situations you fear makes it that much more dif\ufb01cult to remember \nexactly what thoughts tend to occur when you are actually in the situation.\nIf you have dif\ufb01culty identifying your anxious beliefs, we suggest that you try to \nengage with the situations you fear and attempt to identify your assumptions and predic -\ntions while you are still in the situation. With practice, it should get easier to recognize \nyour anxious beliefs. In fact, even if you are unable to identify the speci\ufb01c thoughts that \ncontribute to your anxiety, practicing being in the situation will likely lead to a decrease \nin your fear, as discussed in chapters 7 and 8.", "source": "shyness_social.pdf"}
{"id": "130384720597-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n119STRATEGIES FOR CHANGING ANXIOUS THINKING\nThis section provides an overview of seven different techniques for changing the beliefs \nand predictions that contribute to your social anxiety. These include (1) examining the \nevidence for your beliefs, (2) challenging catastrophic thinking, (3) remembering your \nstrengths, (4) seeing yourself as others do, (5) examining the costs and bene\ufb01ts of your \nthoughts, (6) creating rational coping statements, and (7) conducting behavioral experi -\nments. Along with a description of each strategy, we include exercises to provide oppor -\ntunities to try each technique. Near the end of the chapter, we offer some suggestions \nfor tying together all the pieces and for integrating the cognitive therapy techniques into \nyour larger treatment plan.\nExamining the Evidence\nThe fact that you are anxious about being judged by others in a particular situation \ndoesn\u2019t mean that your fearful predictions and thoughts are true. In fact, what we assume \nothers are thinking is often completely different than what other people actually think \nof us. How many times have you heard someone say, \u201cMy hair looks awful\u201d or \u201cI am \nsuch a loser\u201d and thought to yourself that the individual was just \ufb01ne? If you are consis -\ntently assuming you\u2019re inferior in the eyes of others, you are probably exaggerating or \n misinterpreting other people\u2019s reactions to your appearance, behavior, or performance.\nThe \ufb01rst step toward changing your thoughts is to recognize that your beliefs are \nnot facts. Rather than assuming that your beliefs are true, it is important to treat your \nanxious thoughts as guesses or hypotheses. By examining the evidence, you will be able \nto assess the extent to which your beliefs are true. Remember, your natural tendency", "source": "shyness_social.pdf"}
{"id": "130384720597-1", "page_content": "to assess the extent to which your beliefs are true. Remember, your natural tendency \nmay be to seek out only information that con\ufb01rms your negative beliefs about yourself. \nExamining the evidence involves trying to achieve a more balanced view by looking at all \nthe evidence, especially information that contradicts or disproves your anxious thoughts \nand predictions.\nIn order to examine the evidence for your beliefs, we recommend you get into the \nhabit of asking yourself questions such as the following:\nU\u00caHow do I know for sure that my prediction will come true?\nU\u00caWhat does my past experience tell me about the likelihood of my thoughts \ncoming true?\nU\u00caHave there been times when I have experienced anxious thoughts that \ndidn\u2019t come true?\nU\u00caAre there facts or statistics that can help me to decide whether my predic -\ntion is likely to come true?", "source": "shyness_social.pdf"}
{"id": "960c557bbf03-0", "page_content": "The Shyness & Social Anxiety Workbook\n120U\u00caAre there other possible interpretations for this situation?\nU\u00caHow might another person interpret this situation?\nYou may \ufb01nd it useful to type these questions on a small index card and carry that \ncard as a reminder in your pocket or wallet. Essentially, examining the evidence involves \nfour basic steps: identifying your anxious beliefs, generating alternative beliefs, weigh -\ning the evidence supporting and contradicting your beliefs, and choosing more realistic \nbeliefs. Asking questions similar to those listed above will help you to identify alternative \nbeliefs and to evaluate the evidence concerning your anxious and alternative beliefs. An \nillustration of how to use this strategy to combat a fear of shaking during a presentation \nappears below:\nSteps for Examining the Evidence\n1. Identify the Anxious Thought\nU\u00caThe audience will think I am incompetent if they see my hands shaking \nduring my talk.\n2. Generate Alternative Beliefs\nU\u00caNobody will notice my shaking.\nU\u00caOnly a small number of people will notice my shaking.\nU\u00caPeople who notice my shaking will think I am tired or that I have had \ntoo much coffee.\nU\u00caPeople who notice my shaking will think I am feeling a bit anxious.\nU\u00caIt is normal to shake sometimes, so people will think nothing of it if they \nnotice my shaky hands.\n3. Examine the Evidence\nEvidence Supporting Your Anxious Belief\nU\u00caI believe that my shaking is very extreme.\nU\u00caA few people have commented on my shaky hands over the years.\nU\u00caI tend to notice when other people shake.\nEvidence Supporting Your Alternative Beliefs\nU\u00caI know others with shaky hands, and people don\u2019t seem to think they \nare incompetent.", "source": "shyness_social.pdf"}
{"id": "960c557bbf03-1", "page_content": "are incompetent.\nU\u00caWhen I notice other people shaking, I don\u2019t think they are incompetent.\nU\u00caOften people seem not to have noticed me shaking when I asked them \nif it was noticeable.", "source": "shyness_social.pdf"}
{"id": "a67fea7ee1e0-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n121U\u00caWhen people have noticed my shaking, they haven\u2019t tended to treat me \ndifferently.\nU\u00caThe people in the audience know me well. I can\u2019t imagine that their \nopinions of me would change dramatically based on whether my hands \nshook during a single presentation.\n4. Choose a More Realistic Belief\nU\u00caSome people may notice my shaky hands, but it\u2019s unlikely that they will \nthink I\u2019m incompetent.\nThe following form can be used as you begin to work on examining the evidence \nsupporting and contradicting your anxious beliefs. You may want to make copies of this \nform so that you can continue to use it whenever you encounter a feared situation.", "source": "shyness_social.pdf"}
{"id": "ad233bc06894-0", "page_content": "The Shyness & Social Anxiety Workbook\n122Form for Examining the Evidence\nSituation\nAnxious Beliefs, Predictions, and Interpretations\nAlternative (Non-Anxious) Beliefs, Predictions, and Interpretations\nEvidence Supporting My Anxious Beliefs, Predictions, and Interpretations\nEvidence Contradicting My Anxious Beliefs, Predictions, and Interpretations\nChoosing a More Realistic Way of Thinking", "source": "shyness_social.pdf"}
{"id": "0799ff17a1d1-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n123To further illustrate the process of examining the evidence, here is an example of a \ndiscussion between Stephen and his therapist demonstrating how to \ufb01rst identify anxious \nbeliefs and then challenge those beliefs based on your past experiences.\nTherapist:   What are you afraid will happen if you attend your company picnic next \nweek?\nStephen:    I am nervous that I won\u2019t be able to come up with anything to say to anyone. \nEveryone else will be talking about their children. I\u2019m not in a relationship, \nand I have no kids, so I will have nothing in common with any of them.\nTherapist:   How sure are you that you will have nothing to say?\nStephen:   Probably about 90 percent.\nTherapist:   What that means is that nine out of ten times that you attend an event such \nas this one, you have nothing to say. Is this really true? What happened at \nlast year\u2019s company picnic?\nStephen:    When I \ufb01rst arrived, it was dif\ufb01cult. I stood off to the side and didn\u2019t say \nmuch to others. After a while, people started to include me in their conver -\nsations and it got easier. I think it was especially dif\ufb01cult last year because I \nhad just started at the company and didn\u2019t know anyone very well.\nTherapist:  Were you able to think of things to say?\nStephen:    At \ufb01rst, I struggled. I think it was harder for me than it was for the others, \nbut I was able to think of a few things to talk about, especially later in the \nafternoon.\nTherapist:   Did everyone at last year\u2019s picnic bring a partner or spouse? Did they all talk \nabout their children?", "source": "shyness_social.pdf"}
{"id": "0799ff17a1d1-1", "page_content": "about their children?\nStephen:    No. In fact, there are a few other single people at work. Last year, lots of \npeople ended up talking about work.\nTherapist:   Thinking back to last year\u2019s company picnic, do you still think that you \nwon\u2019t have anything to say at this year\u2019s picnic?\nStephen:    Well, I may not be as talkative as some other people, but I suppose I will \nprobably \ufb01nd something to talk about. Maybe it will be easier this year \nbecause I\u2019ve worked with these people for over a year, so I know them much \nbetter.", "source": "shyness_social.pdf"}
{"id": "105565e8a59e-0", "page_content": "The Shyness & Social Anxiety Workbook\n124Challenging Catastrophic Thinking\nChallenging catastrophic thinking requires shifting the focus of your thoughts from \nhow terrible a particular outcome would be to how you might manage or cope with \nthe situation if it were to occur. One of the most effective ways of overcoming your \n catastrophic thoughts is to ask yourself questions like the following:\nU\u00caSo what?\nU\u00caWhat if my fears actually come true?\nU\u00caHow can I cope with            if it were to occur?\nU\u00caWould              really be as terrible as I think?\nU\u00caDoes this really matter in the big scheme of things?\nU\u00caWill I care about this a month from now? A year from now?\nIn many cases, you will realize that even if your fear does come true, it won\u2019t be the \nend of the world. You will cope with the situation, and your discomfort will pass. Below \nyou will see a discussion between Aimee and her therapist illustrating how to use this \ntechnique to challenge catastrophic thoughts related to asking someone out on a date.\nAimee:   I am terri\ufb01ed of asking anyone out on a date for fear of rejection.\nTherapist:   Is there a particular person whom you have considered asking out?\nAimee:    There is a guy in one of my classes. I\u2019ve sat with him a few times. The class \nends just before lunch, so I\u2019ve thought of asking him to have lunch with \nme.\nTherapist:    What\u2019s stopping you? What do you think might happen if you ask him to \njoin you for lunch?\nAimee:    Mostly, I am afraid he won\u2019t be interested in me. I will put him on the spot", "source": "shyness_social.pdf"}
{"id": "105565e8a59e-1", "page_content": "and he\u2019ll have to come up with an excuse for rejecting my offer. I\u2019m afraid \nhe\u2019ll think I\u2019m stupid, or even worse, he\u2019ll feel sorry for me.\nTherapist:    As we\u2019ve discussed previously, there are many different possible reactions \nthat he could have. Thinking you\u2019re stupid or feeling sorry for you are just \ntwo of many possibilities. Nevertheless, let\u2019s assume for a moment that your \nfears actually are true. What if he does think you are foolish and pathetic?\nAimee:   I don\u2019t know. I hadn\u2019t really thought beyond that. I would feel terrible.", "source": "shyness_social.pdf"}
{"id": "4642f2abfd63-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n125Therapist:   Would it mean that you really are pathetic and stupid?\nAimee:   I suppose not.\nTherapist:    Would it mean that all other people also think you are stupid and \npathetic?\nAimee:   Not really.\nTherapist:   Why not?\nAimee:    Well, his opinion doesn\u2019t re\ufb02ect that of other people. I know my friends \ndon\u2019t think I\u2019m pathetic. At least I hope not.\nTherapist:   If you\u2019re not stupid or pathetic, why else would he reject you?\nAimee:    Perhaps he might have other lunch plans. Or, maybe he already has a \ngirlfriend.\nTherapist:    Those are both possibilities, but let\u2019s come back to your original thoughts. \nWhat if he really thinks you\u2019re pathetic and that\u2019s why he isn\u2019t interested in \nspending time with you?\nAimee:    I guess it wouldn\u2019t matter. Over the past few weeks, I\u2019ve come to recognize \nthat not everyone has to like me. Perhaps it would mean that we\u2019re just not \na good match.\nTherapist:    If he declines your offer for lunch, do you think you will be able to cope \nwith the feelings of rejection?\nAimee:    I think so. It will feel bad at \ufb01rst, but I think I can stop myself from getting \ntoo down on myself.\nOvercoming catastrophic thinking also involves combating the tendencies to con -\ncentrate only on the immediate consequences of some negative experience (for example, \n\u201cPeople will think badly about me during my presentation\u201d) and to forget that your \ndiscomfort will pass after a short time. In reality, the consequences of making a mistake", "source": "shyness_social.pdf"}
{"id": "4642f2abfd63-1", "page_content": "discomfort will pass after a short time. In reality, the consequences of making a mistake \nor of embarrassing yourself are usually minimal and almost never last very long. Even if \npeople notice that you have made a mistake or that you appear to be anxious, they are \nlikely to forget about it after a few minutes. \nWe have included a Decatastrophizing Form toward the end of this chapter to help \nyou challenge your catastrophic thoughts in social situations. The form includes three \ncolumns. In the \ufb01rst column, you should describe the situation that led you to feel \nanxious. In the second column, describe your anxious thoughts and predictions. Now, \nask the questions provided in the previous bulleted list (such as, \u201cSo what?\u201d) and record \nyour noncatastrophic responses in the third column. Following are some examples.", "source": "shyness_social.pdf"}
{"id": "da23a6177dfa-0", "page_content": "The Shyness & Social Anxiety Workbook\n126Column 1 (Examples of Situations)\nU\u00caGiving a presentation\nU\u00caHaving dif\ufb01culty thinking of things to say during a conversation\nU\u00caAttending a party\nU\u00caAsking someone out on a date\nU\u00caWalking through a busy mall\nColumn 2 (Examples of Anxious Thoughts)\nU\u00ca            will think I am stupid.\nU\u00caMy hands will shake.\nU\u00caI will look weak or incompetent.\nU\u00ca            will feel sorry for me.\nU\u00caMy anxiety will be noticed by              .\nColumn 3 (Examples of Noncatastrophic Responses)\nU\u00caEven if             thinks I\u2019m an idiot, it doesn\u2019t mean I \nreally am one. His opinion doesn\u2019t re\ufb02ect that of everyone else.\nU\u00caIt wouldn\u2019t be the end of the world if             noticed \nmy anxiety. Everyone feels anxious from time to time.\nU\u00caWho cares if my hands shake? I have the right to have shaky hands. Probably \nno one will even notice. Even if they notice, they probably won\u2019t care. My \nboss has shaky hands and nobody seems to care.\nU\u00caIf I am ridiculed or laughed at, it would be manageable. Most people get \nteased and ridiculed from time to time. I certainly laugh at other people \nsometimes. Other than the temporary discomfort or embarrassment, it \nwouldn\u2019t really matter in the big scheme of things.\nRemembering Your Strengths\nIf you tend to focus on small mistakes and perceived \ufb02aws in your personality or \nappearance, you will likely continue to feel anxious. For example, if you assume that \neveryone is judging you based on whether your hands shake, you are more likely to", "source": "shyness_social.pdf"}
{"id": "3aa4531cfdca-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n127be nervous when your hands are shaking. Similarly, if you assume that everyone else \nis criticizing you based on ten seconds during your presentation when you lost your \ntrain of thought, you will probably continue to be nervous when giving presentations. \nAlthough it is true that we all judge and criticize other people from time to time, it is \nunlikely that people are noticing and judging the speci\ufb01c behaviors that you assume are \nbeing criticized.\nPeople\u2019s judgments of one another are based on many different dimensions, includ -\ning appearance (for example, height, weight, hair color and style, facial features, cloth -\ning, shoes, and so on), intelligence (for instance, verbal abilities, problem-solving skills, \nknowledge of trivia, and so on), competence (such as abilities to do one\u2019s job well, \ncomputer skills, ability to \ufb01x things around the house), work habits (for example, ten -\ndency to arrive on time, work hard, and not take overly long breaks), athletic abilities \n(like the ability to play tennis, \ufb01tness level, strength), creativity (for instance, musical \nor artistic ability), health habits (such as diet, exercise, smoking, drinking), health status \n(presence of medical problems), social status (type of home, income, type of job), mood \n(happy, excited, sad, angry, fearful), and personality (generosity, empathy, con\ufb01dence, \n politeness, arrogance), to name just a few.\nMost of us are far above average on some dimensions, far below average on some \nother dimensions, and well within average range on most dimensions. The extent to \nwhich a person criticizes you about a particular dimension probably depends on whether", "source": "shyness_social.pdf"}
{"id": "3aa4531cfdca-1", "page_content": "which a person criticizes you about a particular dimension probably depends on whether \nthat person believes that particular domain is important. Although some people may \ncriticize you for appearing nervous, it\u2019s likely that most people couldn\u2019t care less. If you \nassume others are focusing only on those dimensions in which you judge yourself to be \ninferior, you will continue to feel anxious and fearful around other people.\nBecause your natural tendency may be to focus on those areas in which you feel you \ndon\u2019t measure up to others, it may take some practice to recognize dimensions in which \nyou excel or in which you are similar to most other people. As a start, it may be helpful \nto list some of your strengths in the space provided below.\nAreas of Strength\nSeeing Yourself as Others Do\nOne powerful method for challenging the overly harsh standards that you may hold \nfor yourself is to try to see anxiety-provoking situations through another person\u2019s per -\nspective. What if the tables were turned and a close friend came to you for advice and", "source": "shyness_social.pdf"}
{"id": "c5684cb59627-0", "page_content": "The Shyness & Social Anxiety Workbook\n128support after giving a presentation? What if your friend expressed many of the same \nthoughts that you experience when you are in a feared social or performance situation? \nWhat might you say?\nFor example, what if your friend said to you, \u201cI totally blew my presentation. My \nvoice was trembling, and at one point I even lost my train of thought. I\u2019m sure I looked \nlike a complete idiot.\u201d How would you respond to your friend? Most likely you would say \nsomething like, \u201cYou probably did better than you think. Even if you did look anxious, \npeople probably didn\u2019t care.\u201d Or, perhaps you would say something like, \u201cI also feel very \nanxious during presentations. It feels very uncomfortable in the moment, but eventually \nit passes.\u201d\nIt is often much easier to challenge someone else\u2019s anxious thoughts than it is to \nchallenge your own. Therefore, we suggest that you try coping with your own anxious \nthoughts by mentally \u201cstepping out\u201d of the situation for a moment. Imagine that it is \nsomeone else (perhaps a close friend or family member) who is experiencing the anxiety. \nWhat might you tell him or her? Taking the perspective of a close friend may help you \nto challenge your own anxious thoughts.\nAnother helpful method of shifting perspectives is to imagine how you might judge \nsomeone else who exhibits the same anxious behaviors that you do. For example, if you \nare worried that others might criticize you if your voice become shaky, you might ask \nyourself, \u201cAm I critical of other people when I notice their voice shaking?\u201d Most likely, \nyou would not assume someone else to be incompetent, stupid, or weak just because he \nor she seems a bit shy or anxious in a particular situation. Well, the same is true of other", "source": "shyness_social.pdf"}
{"id": "c5684cb59627-1", "page_content": "people. It is unlikely that they will make such harsh judgments of you, even if they do \nnotice that you\u2019re anxious.\nA third strategy for shifting perspectives is to ask yourself how someone who isn\u2019t \nanxious might interpret the situation you fear. For example, if you believe that it\u2019s impor -\ntant to avoid parties if there is any risk at all of looking anxious, you can ask yourself \nhow someone who isn\u2019t anxious might view that situation. You can even imagine how \na particular person (for example, a friend, relative, spouse, or therapist) might view the \nsituation.\nTo summarize, shifting your perspectives involves asking yourself three types of \nquestions:\nU\u00caWhat might I say to a close friend or relative who was having the same \nthought as me?\nU\u00caHow might I view someone else who was exhibiting the same behavior as \nme (shaking, sweating, making a mistake, and so on)?\nU\u00caHow might someone without an anxiety problem view this situation?", "source": "shyness_social.pdf"}
{"id": "39df7a14c974-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n129Examining the Costs and Bene\ufb01ts of Your Thoughts\nAs we have discussed throughout this chapter, anxious thoughts about social and per -\nformance situations are often untrue. However, sometimes they may be true (at least par -\ntially true) and still be a problem. In addition to establishing whether your thoughts are \ntrue, it\u2019s useful to consider whether your thoughts and behaviors are helping you. If they \nare helpful, then they may be worth holding on to. If not, it may be time to let them go.\nAlmost everyone wants to make a good impression and probably no one would \nchoose to be thought of as incompetent, stupid, boring, or weak. In fact, many of the \nanxiety-provoking beliefs held by individuals with excessive social anxiety are similar in \ncontent to those held by people who don\u2019t have problems with social anxiety. Beliefs \nsuch as \u201cIt is important to be liked by other people\u201d and \u201cIt is important to make a posi -\ntive impression\u201d are often helpful beliefs that most of us develop early in life. Making a \ngood impression on others helps us to develop friendships, get promoted at work, and \nimpress our teachers. In fact, many rewards in life depend on being able to in\ufb02uence \nothers in a positive way.\nHowever, excessive social anxiety is usually associated with a tendency to be overly \nconcerned with the opinions of others\u2014so much so that it interferes with your life and \nmay actually lead to a more negative impression on others, particularly if you avoid \nimportant social events. The problem with the beliefs and thoughts associated with \nsocial anxiety is not necessarily that they are untrue (although sometimes they are), but", "source": "shyness_social.pdf"}
{"id": "39df7a14c974-1", "page_content": "social anxiety is not necessarily that they are untrue (although sometimes they are), but \nrather that they are held in an exaggerated and in\ufb02exible way. For example, if the belief \n\u201cI should make a good impression on others\u201d motivates you to do a good job at work, \nthat\u2019s great. If, on the other hand, the same belief makes you feel paralyzed and unable \nto get any work done, that\u2019s a problem.\nIn addition to establishing the accuracy of your anxious beliefs and predictions, it \nmay also be helpful to consider whether your thoughts and behaviors are helping you. \nFollowing is a form that you can use for this exercise. If you are unsure about whether \na particular anxiety-provoking thought is true or false, try examining the costs and ben -\ne\ufb01ts of constantly dwelling on the thought. How would the quality of your life improve \nif you didn\u2019t have the thought?\nDescribe Your Anxious Thought or Prediction\nList the Bene\ufb01ts of Having That Anxious Thought or Prediction", "source": "shyness_social.pdf"}
{"id": "48f428d474ac-0", "page_content": "The Shyness & Social Anxiety Workbook\n130List the Costs of Having That Anxious Thought or Prediction\nRational Coping Statements\nAt the height of your fear, it may be dif\ufb01cult to challenge your anxious thoughts \nusing some of the techniques described in this chapter. You may \ufb01nd that your attention \nis completely focused on trying to get through the situation, and it may seem impossible \nto think logically. Rational coping statements are relatively easy to use and don\u2019t require \nthe same level of logical analysis as other techniques, such as examining the evidence \nand evaluating the costs and bene\ufb01ts of your anxious thoughts. Rational coping state -\nments are short \u201cnonanxious\u201d sentences that may help to combat your anxious thinking. \nExamples include the following:\nU\u00caIt would be manageable if             didn\u2019t like me.\nU\u00caIt\u2019s okay to blush in front of others.\nU\u00caPanic attacks are uncomfortable but not dangerous.\nU\u00caIt is okay to look anxious during a presentation.\nU\u00caPeople don\u2019t seem to notice my shaky hands.\nYou may \ufb01nd it helpful to write or type several coping statements on an index card \nand carry the card with you as a reminder. When you are in an anxiety-provoking situ -\nation, you can take the card out of your wallet or purse and remind yourself of one or \nmore of these statements, thereby combating your anxious thoughts. Choose statements \nthat are most relevant to you. Also, choose statements that are believable. For example, \nthere is no point telling yourself, \u201cI am not going to be anxious\u201d if you always feel \nanxious when giving speeches and you are about to give a speech. A more believable \nalternative is, \u201cIt\u2019s not the end of the world if I become anxious.\u201d", "source": "shyness_social.pdf"}
{"id": "48f428d474ac-1", "page_content": "alternative is, \u201cIt\u2019s not the end of the world if I become anxious.\u201d\nIn the following spaces, record \ufb01ve rational coping statements that are relevant to \nyour own particular anxious beliefs.\n1.  \n2.  \n3.", "source": "shyness_social.pdf"}
{"id": "1cf3b2bf0eb6-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n1314.  \n5.  \nBehavioral Experiments\nCognitive therapy involves examining the validity of your beliefs and thoughts in \nthe same way that a scientist examines the validity of a scienti\ufb01c theory or hypothesis. \nIn fact, the experiment is the most powerful strategy scientists have to test their own \nbeliefs. In cognitive therapy for social anxiety, experiments involve challenging anxious \nbeliefs by setting up small behavioral tests to see whether a belief is in fact valid. Through \na series of repeated behavioral experiments, it is likely that you will disprove many of \nthe beliefs and predictions that contribute to your fear and anxiety. Some examples of \nspeci\ufb01c experiments that can be used to test the validity of various anxiety-provoking \nthoughts are listed below.\nAnxiety-Provoking Thought Example of Behavioral Experiment\nIt would be terrible to have my hand  \nshake while I hold a glass of water.Purposely shake your hand while you hold \na glass of water. For a true test of your \nbeliefs, let the water spill all over you! \nThen see if it really is so terrible.\nI will make a fool of myself at my job  \ninterview tomorrow, so why bother going?Go to the job interview and see what \nhappens.\nI can\u2019t cope with being the center of \nattention.Do something to draw attention to your -\nself. For example, arrive to class late, drop \nyour keys, wear your shirt inside out, or \nknock over some unbreakable items in a \nsupermarket.\nIt would be terrible to seem stupid or \nincompetent.Line up at a store and after your items \nhave been rung up, explain to the cashier \nthat you have forgotten your money.", "source": "shyness_social.pdf"}
{"id": "1cf3b2bf0eb6-1", "page_content": "have been rung up, explain to the cashier \nthat you have forgotten your money.\nI will be rejected if I ask a coworker to \nhave dinner with me.Invite your coworker for dinner and check \nout his or her reaction.\nWhen selecting possible experiments, try to choose practices in which you have \nlittle to lose. For example, don\u2019t tell your boss how much you hate him, just to see what \nhappens! Try to select experiments in which the worst that will happen is possible dis -\ncomfort or temporary embarrassment. Remember that the more social risks you take, the \nmore often they will pay off. Along the way, however, you will also experience rejection \nfrom time to time. If you don\u2019t take risks, you will never be rejected\u2014but you will also", "source": "shyness_social.pdf"}
{"id": "f1613a2bf5d1-0", "page_content": "The Shyness & Social Anxiety Workbook\n132never experience the bene\ufb01ts of taking social risks, including improved relationships, a \nbetter job, and other possible rewards.\nIn the spaces below, imagine and record some experiments you could try in order to \ntest out your particular anxious thoughts. In the \ufb01rst column, write down your anxious \nbelief. In the second column, design a small experiment that will provide a good test of \nwhether your belief is true.\nAnxious Thought      Behavioral Experiment\n              \n              \n              \n              \nThe next few chapters discuss strategies for confronting the very situations and \nfeelings that you fear. As you will see, exposure to feared situations is actually a type \nof behavioral experiment. By repeatedly exposing yourself to situations that make you \nanxious, you will learn that your fears often don\u2019t materialize.\nUSING A THOUGHT RECORD OR  \nCOGNITIVE DIARY\nThroughout this chapter, we have included various forms and diaries to be used for \nchallenging anxious thoughts. In this section, we now provide a more general Social \nAnxiety Thought Record that can be used whenever you experience anxiety in a social \nsituation. Unlike the other forms in this chapter, which are each designed for use with a \nparticular technique (examining the evidence, overcoming catastrophic thinking, and so \non), the Social Anxiety Thought Record is designed to be used with any of the cognitive \n strategies. At the end of this chapter is a blank form, as well as a completed sample.\nIt really doesn\u2019t matter which form you use to record and change your thoughts. You \ncan use the forms provided in this chapter, or you can design your own. The diaries in \nthis chapter are only suggestions. The main point of these diaries is to get you into the", "source": "shyness_social.pdf"}
{"id": "f1613a2bf5d1-1", "page_content": "habit of paying attention to your thoughts and actively trying to change them. Once \nthe new patterns of thinking become second nature, it will no longer be necessary to \nrecord your thoughts on paper. In the meantime, we recommend that you use some \ntype of diary or form several times per week after encountering feared social or perfor -\nmance situations. The best times to complete the forms are either before entering the \n situation (as a way of preparing for the encounter) or immediately afterward (as a way of \n challenging any anxious thoughts that occurred while you were in the situation).", "source": "shyness_social.pdf"}
{"id": "23298cb9a829-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n133Instructions for Completing the Social Anxiety  \nThought Record\nColumn 1: Date and Time\nRecord the date and time. \nColumn 2: Situation\nDescribe the situation or trigger for your fear. Typical examples might include the \nfollowing:\nU\u00caGave a presentation\nU\u00caWent to a meeting\nU\u00caPerson was watching me on the subway\nU\u00caAte lunch with a coworker\nU\u00caI was blushing\nU\u00caMy hands shook in front of my boss\nU\u00caWent to a party\nU\u00caHad to do an oral book-report for class\nU\u00caWas introduced to my sister\u2019s new boyfriend\nU\u00caWent on a blind date\nColumn 3: Anxiety-Provoking Thoughts and Predictions\nIn the third column, list any anxious thoughts that occur in response to the situa -\ntion and triggers reported in column 2. Usually these thoughts will be predictions of \ndanger, embarrassment, and so on. Often these thoughts will be automatic or almost \nunconscious. It will take practice to identify them. Try to come up with very speci\ufb01c \nthoughts. A thought such as, \u201cSomething bad will happen\u201d is too vague. Typical  examples \nof  speci\ufb01c anxious thoughts include the following:\nU\u00caPeople will notice my blushing and think I am strange\nU\u00caPeople will notice that I am nervous\nU\u00caI will make a fool of myself\nU\u00caPeople will think I am stupid\nU\u00caPeople will see me for the idiot I really am", "source": "shyness_social.pdf"}
{"id": "db4db4bd2e66-0", "page_content": "The Shyness & Social Anxiety Workbook\n134U\u00caPeople will think I\u2019m ugly\nU\u00caI will have to leave the situation \nU\u00caI am incompetent and clumsy\nU\u00caI need an alcoholic drink to feel comfortable\nU\u00caPeople can always tell how I am feeling\nU\u00caAnxiety is a sign of weakness\nU\u00caI\u2019ll be viewed as boring\nU\u00caPeople will not like me\nU\u00caI will have nothing to say\nColumn 4: Anxiety Before (0\u2013100)\nRate your anxiety level before countering your anxiety-provoking thoughts. Use a 0 \nto 100 point scale, where 0 = no anxiety and 100 = extreme anxiety.\nColumn 5: Alternative Thoughts and Predictions\nRecord examples of alternative thoughts and predictions. For example, if you believe \nthat people will think you are strange if you blush, alternative predictions might include \nsuch thoughts as (1) nobody will notice my blushing, (2) people who notice my blushing \nwill think I am hot or not feeling well, and (3) people who notice my blushing will think \nnothing of it.\nColumn 6: Evidence and Realistic Conclusions\nConsider the evidence for your anxiety-provoking thoughts as well as your alterna -\ntive thoughts. For example, if you fear blushing, you might record your observations that \nmost people don\u2019t mention that they notice your blushing, and that even when people \ndo notice that you are blushing, they still seem to enjoy your company and they still \ntreat you well. In this column, you should also record a realistic conclusion based on the \nevidence. For example, you might record, \u201cMany people don\u2019t seem to notice my blush -", "source": "shyness_social.pdf"}
{"id": "db4db4bd2e66-1", "page_content": "ing, and even when someone does notice it, there are no real consequences other than \nmy temporary embarrassment.\u201d\nColumn 7: Anxiety After (0\u2013100)\nRate your anxiety level after countering your anxiety-provoking thoughts. Use a 0 \nto 100 point scale, where 0 = no anxiety and 100 = extreme anxiety.", "source": "shyness_social.pdf"}
{"id": "2f723644bed0-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n135INTEGRATING COGNITIVE STRATEGIES INTO \nYOUR TREATMENT PLAN\nThe cognitive techniques described in this chapter are not meant to be used on their \nown. Rather, they should be used as part of a comprehensive treatment plan that includes \nexposure to feared situations. Exposure-based treatments are discussed in chapters 7 \nthrough 9. We recommend that you \ufb01rst practice the cognitive techniques for a few \nweeks before formally beginning exposure practices. Learning to manage your anxiety \nby changing your thinking will help you when confronting the situations that you fear. \nIn addition to exposure and cognitive therapy, your treatment may also include medica -\ntion (see chapter 5) and social-skills practices (see chapter 10), depending on your own \npersonal needs and preferences.\nA WORD TO SIGNIFICANT OTHERS, FRIENDS, \nAND FAMILY MEMBERS\nIf you are working with a loved one who is trying to overcome his or her social anxiety, \nyou can help him or her to change anxiety-provoking thoughts into more realistic \nthoughts by engaging in calm, logical discussions about the situations he or she fears. \nThis process should always be done in a supportive way, and you should be careful \nnot to put your loved one down for having anxiety-provoking beliefs (after all, we all \nhave irrational thoughts from time to time). You should also be careful not to tell your \nloved one what he or she should  be thinking. Rather, your loved one should draw his or \nher own conclusions based on the evidence. Finally, remember that your role is to be \nsupportive\u2014not to nag or pressure your loved one into making changes or to argue \nabout how to interpret anxiety-provoking situations. You and your loved one should", "source": "shyness_social.pdf"}
{"id": "2f723644bed0-1", "page_content": "about how to interpret anxiety-provoking situations. You and your loved one should \ndiscuss what role he or she would like you to have, and how you can best facilitate the \nprocess of change.\nTROUBLESHOOTING\nProblem:  I have dif\ufb01culty identifying my anxious thoughts.\nSolution:   Ask yourself questions such as, \u201cWhat might           think \nabout me?\u201d and \u201cWhat do I think will happen in this situation?\u201d If, after \ntrying to answer these questions, you are still unable to identify your \nanxious beliefs, try to detect your thoughts while you are actually in \nthe situation you fear. If you are unable to identify speci\ufb01c thoughts and \npredictions, don\u2019t worry. You can still bene\ufb01t from the exposure-based \nstrategies discussed in chapters 7 through 9.", "source": "shyness_social.pdf"}
{"id": "7190c10cf3e1-0", "page_content": "The Shyness & Social Anxiety Workbook\n136Problem:   I have dif\ufb01culty believing the alternative, nonanxious, rational \nthoughts.\nSolution:   Sometimes the cognitive techniques seem super\ufb01cial when a person \ufb01rst \nstarts to use them. Over time, the new nonanxious thoughts should \nbecome more believable. If not, the exposure-based strategies (chap -\nters 7 through 9) are among the most powerful methods for changing \nanxious thoughts and will likely help. Sometimes, changing thoughts \nthrough \ufb01rsthand experience in a feared situation is more effective than \ntrying to change thoughts by simply trying to think differently.\nProblem:   When I am in a social situation, I am too anxious to think clearly, so I \ncan\u2019t use the cognitive strategies.\nSolution:   Try using the cognitive strategies before you enter the situation. If this \nis not practical, try using them after you have been in the situation for \na while (your fear should decrease over time) or even after leaving the \nsituation.\nProblem:   I can\u2019t be bothered completing the monitoring forms. They are confus -\ning, and they take too long to complete.\nSolution:   There are many different ways to learn the techniques described in \nthis chapter. The forms and diaries are designed to make the process \neasier. However, if they are getting in the way of using the strategies, \ntry developing a simpler form (for example, you may want to use a two-\ncolumn form\u2014with one column for recording your anxious thoughts \nand another column for recording your new nonanxious thoughts). \nAlternatively, you can even forget about the forms and diaries and \nsimply use the techniques in your head.", "source": "shyness_social.pdf"}
{"id": "12867b17ff11-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n137A SUMMARY GUIDE TO CHALLENGING \nTHOUGHTS\nThis chapter includes a large number of suggestions and strategies for identifying and \nchanging your anxious thoughts. Now that you have had a chance to read through the \nchapter and complete some of the exercises, we encourage you to continue using the \ncognitive techniques to cope with your social and performance anxiety. Generally, using \nthe cognitive strategies will involve the following steps:\n1. Identify your anxious thoughts, predictions, and interpretations.\n2. Examine the validity of your anxious predictions using some of the tech -\nniques described in this chapter (such as examining the evidence, taking the \nperspective of others, examining the costs and bene\ufb01ts of your thoughts, \nconducting behavioral experiments). Are your predictions realistic? For \nexample, will others really think                 about \nyou?\n3. Examine the validity of your catastrophic thoughts by asking the question, \n\u201cSo what if my anxious thoughts are true?\u201d For example, \u201cWhat if a few \npeople in the audience really think my presentation is awful? How might I \ncope with that?\u201d\n4. Use the Social Anxiety Thought Record to identify and challenge your \nanxious thoughts on paper.", "source": "shyness_social.pdf"}
{"id": "0a467d842040-0", "page_content": "The Shyness & Social Anxiety Workbook\n138\nDecatastrophizing Form\nSituation Anxious Thoughts and Predictions\n(What do I think will happen?)Noncatastrophic Responses\n(What if my thoughts come true?)", "source": "shyness_social.pdf"}
{"id": "8898131ce306-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n139Social Anxiety Thought Record\nDate and \nTimeSituationAnxiety-Provoking \nThoughts and \nPredictionsAnxiety \nBefore\n(0\u2013100)Alternative Thoughts \nand PredictionsEvidence and Realistic \nConclusionsAnxiety \nAfter\n(0\u2013100)\n\u00a9 2008 Martin M. Antony", "source": "shyness_social.pdf"}
{"id": "e8b63b9d2003-0", "page_content": "The Shyness & Social Anxiety Workbook\n140\nSocial Anxiety Thought Record\u2014Completed Sample\nDate and \nTimeSituationAnxiety-Provoking \nThoughts and \nPredictionsAnxiety \nBefore\n(0\u2013100)Alternative Thoughts \nand PredictionsEvidence and Realistic \nConclusionsAnxiety \nAfter\n(0\u2013100)\nApril 3,  \n2 PMMeeting at work I will say something stupid; \npeople will think I\u2019m an idiot.90 I will say something intel -\nligent. I will say something \nthat is neither stupid nor \nintelligent. Some people will \nthink I\u2019m smart; some people \nmay think I am of average \nintelligence. Whatever I \nsay won\u2019t change what my \ncoworkers already think about \nmy intelligence.  My boss asked me to speak at the meeting, \nso she must think I have something worth -\nwhile to say. Everyone says stupid things \nfrom time to time, and there is no reason to \nthink that I shouldn\u2019t also say dumb things \nsometimes. Nothing terrible will happen if I \nsay something stupid. Everyone in the room \nalready knows me. Even if someone thinks I \nam stupid, it won\u2019t be the end of the world.50\nApril 5,  \n7 PMEating dinner with \na friend; my hands \nare shakingMy shaking hands will be \nnoticeable. My friend will \nthink that I am nervous and \nwill see that as a weakness.70 Maybe my friend won\u2019t \nnotice my hands shaking. \nEven if he notices, he may \nnot think it is due to anxiety. \nEven if he thinks it is due to \nanxiety, he may not see it as \na weakness.", "source": "shyness_social.pdf"}
{"id": "e8b63b9d2003-1", "page_content": "anxiety, he may not see it as \na weakness.  \n I have known my friend for years. He \nknows that I get nervous sometimes, and he \nstill wants to spend time with me. He gets \nnervous in situations that don\u2019t bother me \n(he is afraid of \ufb02ying). I have the right to \nhave shaky hands sometimes!  \n 45", "source": "shyness_social.pdf"}
{"id": "87068e4316f8-0", "page_content": "Changing Your Anxious Thoughts and Expectations\n141April 7,  \n3 PMReturning an item \nto a storeThe cashier will think I\u2019m \nstupid for buying this item in \nthe \ufb01rst place. I won\u2019t be clear \nwhen trying to explain what \nI want to do. The cashier \nwon\u2019t let me return the item, \nand I won\u2019t know how to \nrespond.70 The cashier will not think I \nam stupid. I will be able to \nexplain what I want to do. \nThe cashier will allow me to \nreturn the item. Even if I am \nanxious, I will be able to cope \nwith this situation.I have returned items to stores before, and it \nalways seems to work out. Chances are that \nit will work out this time, too. Returns are \nallowed within 30 days, so I have the right \nto return this item. Even if I seem nervous, \nthe cashier doesn\u2019t have the right to turn \ndown my request. If I can\u2019t think of the \nright words, I can just take my time until \nthe words come to me.  20\n\u00a9 2008 Martin M. Antony", "source": "shyness_social.pdf"}
{"id": "8737838f3451-0", "page_content": "CHAPTER 7\nConfronting Your Fears \nThrough Exposure\nChapter 6 provided a detailed overview of cognitive strategies that have been shown to \nbe useful for changing anxious patterns of thinking. Almost all of the cognitive tech -\nniques involve learning to think differently about social and performance situations by \n(1) broadening the possible range of interpretations and beliefs that you can hold for a \nparticular social situation, and (2) considering all the evidence before assuming that a \nspeci\ufb01c thought is true.\nThis chapter provides an introduction to a number of techniques that are useful for \nchanging the behaviors that maintain your anxious beliefs and feelings. Essentially, these \nstrategies involve confronting your fears directly by exposing yourself to the situations \nand the feelings that you currently fear and avoid. This chapter starts with a review of \nthe behaviors that contribute to social anxiety and a summary of the strategies that can \nbe used to change these behaviors. The remainder of the chapter provides more detailed \ndescriptions of the underlying principles of exposure and the best ways of conducting \nexposure-based therapy.\nChapters 8 and 9 build directly on the content of this introductory chapter by provid -\ning more in-depth instructions for exposure to social situations (chapter 8) and exposure \nto feared sensations (chapter 9). The exercises described in chapters 7 through 9 should \nbe used after you have had a chance to practice some of the cognitive methods described \nin chapter 6. We recommend that you begin to learn about exposure by reading chapters \n7 and 8 and that you practice the situational exposure exercises for at least three to \ufb01ve \nweeks before moving on to chapter 9. Then, we suggest that you read chapter 9 and make \nsome attempts to expose yourself to feared sensations, if these exercises are relevant", "source": "shyness_social.pdf"}
{"id": "8737838f3451-1", "page_content": "some attempts to expose yourself to feared sensations, if these exercises are relevant \nto you. As reviewed in chapter 9, exposure to physical sensations may be useful if you", "source": "shyness_social.pdf"}
{"id": "17cb5b33b843-0", "page_content": "The Shyness & Social Anxiety Workbook\n144are fearful of experiencing particular feelings (for instance, sweating, shaking, blushing, \nracing heart) associated with being anxious or nervous. If you are not fearful of these \nbehaviors, then the strategies described in chapter 9 will not be as important.\nBEHAVIORS THAT CONTRIBUTE TO  \nSOCIAL ANXIETY\nAll organisms try to avoid situations that cause fear, pain, or discomfort. Avoidance is a \nmethod of protecting oneself from possible danger. In the short term, staying away from \nperceived threats is a very effective way of decreasing or preventing these uncomfort -\nable feelings. Your experience has probably taught you that confronting feared situations \ncauses you to feel overwhelmed and that avoiding or escaping from feared situations \nleads to a sense of relief. However, avoiding the situations, objects, and feelings that \nmake you anxious is also a guaranteed way to ensure that your fear will continue over the \nlong term. The likelihood of threat in the social situations that you avoid is probably very \nlow. Avoidance can actually do more harm than good, particularly in the long term.\nBy avoiding the situations that make you uncomfortable, it may seem as though you \nprevent your feared negative consequences from occurring. Just as a person who fears \n\ufb02ying may believe that avoiding a \ufb02ight has protected him or her from experiencing \na possible plane crash, you may believe that avoiding social or performance situations \nprotects you from experiencing various social catastrophes, such as being humiliated or \ncriticized by others. Of course, statistically, the risk of dying in a plane crash is close \nto zero (about one in ten million, according to some sources). In other words, the risk", "source": "shyness_social.pdf"}
{"id": "17cb5b33b843-1", "page_content": "of being in a plane crash is almost identical (close to zero) whether you \ufb02y or not! The \nsame may be said of public speaking, attending parties, and other social situations. The \nrisk of actual threat or danger is signi\ufb01cantly less than socially anxious individuals usually \nassume. In fact, the long-term consequences of avoiding social situations are often far \ngreater than the risks of confronting these situations.\nExposure to feared situations and feelings is a very powerful method of learning that \navoidance is neither necessary nor helpful in the long run. By confronting your fears, you \nwill discover that many of your anxiety-provoking beliefs and interpretations are untrue \nor exaggerated. In addition, your interpersonal skills will improve as you will have more \nopportunities to practice various types of social interaction and performance. In other \nwords, not only will you become more comfortable making small talk, giving speeches, \nor dealing with con\ufb02ict situations, you will also become more effective and competent \nat mastering these challenging situations.\nThere are three main types of anxious behaviors that we will review here. Each of \nthese is a potentially harmful habit because it prevents your fear from decreasing over \nthe long term. These behaviors include (1) avoiding feared social and performance situa -\ntions, (2) avoiding feared sensations and feelings, and (3) subtle avoidance strategies and \nsafety behaviors.", "source": "shyness_social.pdf"}
{"id": "99de454ac36c-0", "page_content": "Confronting Your Fears Through Exposure\n145Avoidance of Social Situations\nAvoiding social situations such as public speaking, making conversation, attending \nmeetings, dating, and working out at the gym prevents you from learning that these \nsituations are safe and that your fears are generally unwarranted. Escaping early from \nthese situations (for instance, leaving a party after a few minutes) can also have a nega -\ntive impact on your fear by reinforcing your experience that being in the situation makes \nyou uncomfortable, and leaving the situation provides relief and a reduction in fear. In \nreality, staying in a situation despite the fear that it arouses also leads to a reduction in \nfear. Fear may take longer to decrease when you stay in the situation, but the long-term \nbene\ufb01ts will be greater. By staying until your fear decreases, you will learn that you can \nbe right in the middle of the situation and feel relatively comfortable. Strategies for \novercoming avoidance of feared situations are discussed throughout this chapter, as well \nas in chapter 8.\nAvoidance of Feared Sensations\nAs we discussed previously, in addition to avoiding certain situations, you may also \navoid feeling certain sensations or feelings, particularly in social situations. Perhaps you \navoid eating hot foods that cause you to feel \ufb02ushed when you\u2019re dining with friends or \nrelatives. Alternatively, you may avoid wearing warm clothes while speaking in public, in \ncase they cause you to sweat. Avoiding sensations such as sweating and blushing reinforces \nyour beliefs that these sensations and feelings are dangerous. If you are fearful of expe -\nriencing particular symptoms in the presence of others, you will likely \ufb01nd that exposing \nyourself to these feelings can help you to become more comfortable with them. The goal", "source": "shyness_social.pdf"}
{"id": "99de454ac36c-1", "page_content": "yourself to these feelings can help you to become more comfortable with them. The goal \nis to reach a point at which sensations, like shaking or a racing heartbeat, are, at worst, \nmildly uncomfortable but not frightening. The general principles discussed throughout \nthis chapter will be relevant to overcoming your fear of physical symptoms. However, \nspeci\ufb01c exercises for overcoming these fears are discussed more thoroughly in chapter 9.\nSubtle Avoidance Strategies and Safety Behaviors\nSubtle avoidance behaviors (also called safety behaviors ) are not-so-obvious strate -\ngies that people often use to cope with anxiety-provoking situations. Unlike completely \navoiding a feared situation, subtle avoidance strategies involve partial avoidance of the \nsituation. Often these behaviors are not noticeable to others. In fact, they may be so \nsubtle that even you are not aware of them. As is the case with more obvious types of \navoidance, learning to let go of your subtle forms of escape will help you to overcome \nyour fear, just as removing training wheels is an important step in learning to ride a \nbicycle, and letting go of crutches is an important step in relearning to walk after an \ninjury. We will now discuss some examples of subtle avoidance strategies.", "source": "shyness_social.pdf"}
{"id": "cbd374f221c4-0", "page_content": "The Shyness & Social Anxiety Workbook\n146Distraction.  Distraction involves escaping from anxious thoughts and feelings by focus -\ning on thoughts or images that are more pleasant or by keeping yourself busy with \ndistracting activities. For example, while attending a party, you might offer to help serve \nfood or drinks so that you are constantly busy with some activity and your mind is dis -\ntracted from the anxious feelings that you might otherwise be experiencing. Or, while \ntraveling on a bus or train, you might always be sure to bring a book or portable radio \nto distract yourself from feeling anxious about making eye contact with others or from \nthinking about what others might be thinking about you. Such distractions may help you \nto feel comfortable while in social or performance situations, but in the long term they \nprevent you from learning that you can manage the situation without having to rely on \nsubtle avoidance.\nOverprotective behaviors. Overprotective behaviors are small things that you may do \nto feel safer in the situations that you fear. Examples may include the following:\nU\u00caWearing extra makeup or a turtleneck sweater to hide blushing\nU\u00caFinding out who else will be at a party before deciding whether to attend\nU\u00caWearing gloves to hide shaking hands\nU\u00caSitting down or leaning against a podium while giving a presentation\nU\u00caEating in a dimly lit restaurant so your date won\u2019t notice your anxiety\nU\u00caWearing sunglasses to help avoid making eye contact\nU\u00caAlways attending social events with a friend so you can avoid talking to \npeople who you don\u2019t know well\nWhen designing exposure practices, it is important that you also try to eliminate \nthese subtle safety behaviors.\nOvercompensating for perceived de\ufb01cits. Overcompensating involves working extra", "source": "shyness_social.pdf"}
{"id": "cbd374f221c4-1", "page_content": "hard to make sure that your fearful predictions don\u2019t come true. For example, if you \nare afraid of looking foolish during a presentation, you may spend days rehearsing and \nmemorizing what you will say. If you\u2019re fearful of making small talk, you may spend \nhours preparing topics of conversation and rehearsing what you might talk about. If \nyou are afraid of looking unattractive, you may put too much effort into \ufb01xing your \nhair, choosing your clothes, or building your muscles at the gym. In many cases, these \nsituations might be managed with less effort, leaving time and energy for other things. \nExposure practices should be designed to eliminate any tendencies to overprepare or \novercompensate for \ufb02aws that may not even be present. For example, instead of spend -\ning hours memorizing a presentation, try giving your talk with only minimal (but still \nadequate) preparation.", "source": "shyness_social.pdf"}
{"id": "80e8c4d1120c-0", "page_content": "Confronting Your Fears Through Exposure\n147Excessive checking and reassurance seeking. Excessive checking involves spending too \nmuch time and effort trying to \ufb01nd out whether you are perceived by others in a positive \nlight. We all engage in occasional checking (for example, looking in the mirror at a party, \nasking a coworker whether she enjoyed your presentation). In fact, we recommend that \nyou occasionally continue to check on other people\u2019s reactions to you and your actions. \nChecking and receiving reassurance are helpful ways of testing out your beliefs. However, \nif you ask for reassurance or check too frequently, this may be a behavior you want to \ndecrease. The key is moderation. Occasional checking is helpful, but constant checking \ncan be a problem. Constantly obtaining reassurance about your performance is like con -\nstantly checking with your doctor whenever you experience an unusual sensation. Never \ngoing to the doctor may cause you serious health problems that might otherwise have \nbeen detected early or prevented. But going to the doctor several times a week to check \nout every ache and pain can back\ufb01re; your doctor may stop taking your concerns and \ncomplaints seriously. Constant requests for reassurance can also back\ufb01re, having the exact \neffect that you are trying to avoid\u2014namely a negative response from others.\nSubstance use. Substance use can undermine the effects of exposure by arti\ufb01cially low -\nering your level of fear in social and performance situations. For exposure to be effec -\ntive, it\u2019s important for you to experience some degree of fear. It is also important for \nyou to learn that your fear will usually decrease naturally if you stay in the situation. \nDrinking alcohol or using other drugs whenever you are in a situation that makes you", "source": "shyness_social.pdf"}
{"id": "80e8c4d1120c-1", "page_content": "Drinking alcohol or using other drugs whenever you are in a situation that makes you \nanxious will prevent you from learning that your anxiety will decrease even without the \ndrug or alcohol. When designing exposure practices, we recommend that you not drink \nalcohol or use drugs during the practice. If you want to have a glass of wine or a beer at \na party, try to wait until after your fear has decreased somewhat.\nA STEP-BY-STEP OVERVIEW FOR CONDUCTING \nEXPOSURE-BASED TREATMENTS\nThe main steps involved in any exposure-based treatment program are initial assessment, \nplanning appropriate practices, carrying out the practices, and taking steps to maintain \nthe improvements over the long term.\nInitial Assessment\nWe discussed the issue of assessment in chapter 3. To plan effective exposure prac -\ntices, you will need to know the situations and sensations that you fear and avoid as \nwell as becoming aware of the different variables that affect your fear level. When you \ncompleted the exercises in chapter 3, you probably identi\ufb01ed a number of variables \nthat affect your fear level when you are in a social or performance situation that causes \nyou to feel uncomfortable. You should review the relevant sections of chapter 3 before \n beginning your exposure practices.", "source": "shyness_social.pdf"}
{"id": "fca42db049a1-0", "page_content": "The Shyness & Social Anxiety Workbook\n148Planning Appropriate Practices\nPlanning your exposure practices starts with developing an exposure  hierarchy . An expo -\nsure hierarchy is a list of feared situations ranked in order of dif\ufb01culty, from least fear \nprovoking at the bottom, to most fear provoking at the top. Chapter 8 provides exam -\nples of hierarchies and includes instructions on how to develop your own hierarchy for \nsituational exposure. Chapter 9 provides sample hierarchies and instructions for devel -\noping a hierarchy for exposure to feared sensations. Developing an exposure hierarchy \nwill provide a structure that will allow you to begin with easier exercises and work your \nway up to more dif\ufb01cult ones.\nCarrying Out the Practices\nOnce you\u2019ve identi\ufb01ed some practices likely to be helpful, the next step is to begin \ncarrying them out. Generally, exposure begins with more manageable situations and \nworks up to more and more dif\ufb01cult situations. As confronting the situations becomes \neasier, you should begin to let go of the subtle forms of avoidance that were discussed \nearlier. Later, after practicing situational exposure for several weeks (as described in \nchapter 8), it may be useful to add exercises involving exposure to feared feelings and \nsensations (as described in chapter 9).\nExposure practices should be structured, planned in advance, and carried out fre -\nquently. The ways in which exposure practices are carried out affect whether the prac -\ntices are helpful or not. Exposure can actually increase your fear if not done properly. \nThe remaining sections of this chapter provide suggestions for the best ways to conduct \nexposure to maximize the chances of decreasing your fear.\nMaintaining Your Improvements\nIn order to maintain your improvements, it\u2019s important that you continue occasional", "source": "shyness_social.pdf"}
{"id": "fca42db049a1-1", "page_content": "In order to maintain your improvements, it\u2019s important that you continue occasional \npractices even after your fear has decreased. These strategies are explored in greater \ndetail in chapter 11.\nTYPES OF EXPOSURE\nThis section discusses three different dimensions that should be taken into account when \nplanning exposure practices. They are (1) exposure to social situations vs. feared sensa -\ntions; (2) imagined vs. live exposure; and (3) gradual vs. rapid exposure.", "source": "shyness_social.pdf"}
{"id": "916578083359-0", "page_content": "Confronting Your Fears Through Exposure\n149Exposure to Social Situations vs. Feared Sensations\nSituational exposure involves exposing oneself to places and situations that produce \nanxiety. Overcoming social and performance anxiety almost always includes situational \nexposure as a component. In other words, to become more comfortable with public \nspeaking, meeting strangers, or lunching with your coworkers, you will need to practice \nthese activities.\nSome people with social and performance anxiety may also bene\ufb01t from exposure to \nsensations. This form of exposure is sometimes called interoceptive exposure, and it involves \npracticing exercises that trigger particular physical sensations. For example, spinning in a \nchair can be used to induce dizziness, and running up and down the stairs will make your \nheart race. Exposure to sensations is useful for people who are fearful of experiencing \nuncomfortable physical feelings.\nIf you are not afraid of the physical sensations that you experience when anxious, \nthere is no need to practice these exercises. However, if you are frightened by the physi -\ncal sensations you experience in social situations, you may \ufb01nd it helpful to practice \nexperiencing these feelings purposely until they no longer frighten you. Exposure to \nsensations can be combined with situational exposure so that feared physical feelings are \npurposefully brought on during the course of the exposure to feared situations. Chapter \n9 provides a detailed description of how to use interoceptive exposure to reduce your \nfear of sensations.\nImagined vs. Live Exposure\nExposure can be conducted in your imagination (imagining being in a feared situa -\ntion) or in real life (actually entering the feared situation). Generally, whenever possible, \nwe recommend that live exposure (also called in vivo exposure ) be used rather than imag -", "source": "shyness_social.pdf"}
{"id": "916578083359-1", "page_content": "we recommend that live exposure (also called in vivo exposure ) be used rather than imag -\nined exposure. Although both approaches can lead to a reduction of fear, live exposure \nhas two big advantages. First, some people have dif\ufb01culty imagining feared situations in \na way that actually arouses their fear; and, second, there is evidence that live exposure \nis more effective at reducing fear (Emmelkamp and Wessels 1975).\nNevertheless, under certain circumstances, imagined exposure may be helpful. If \nyou are too fearful to enter a situation in real life, you can use imagined exposure as a \nstepping-stone to the real situation. For example, if you are planning to ask someone out \non a date, you might consider using an imagined exposure to the situation at \ufb01rst. Once \nyou have become more comfortable imagining the situation, trying the real thing might \nbecome easier. Also, imagined exposure can be helpful when the situation is impracti -\ncal or impossible to practice in real life. For example, if you must give a presentation \nto a group of 200 people, you may not be able to practice it in front of a large group. \nInstead, imagining a large group in your mind\u2019s eye might be a good way to practice for \nthe actual presentation when you are preparing your talk.", "source": "shyness_social.pdf"}
{"id": "926972411e6e-0", "page_content": "The Shyness & Social Anxiety Workbook\n150Situational role-play  is a compromise between imagined exposure and live exposure. \nRole-play involves rehearsing being in a particular situation with the help of a friend, \nfamily member, or therapist. For example, before exposing yourself to a real job  interview, \nyou could practice mock interviews with other individuals posing as the interviewers. \nOr, you could ask your family or friends to act as the audience while you practice a pre -\nsentation. These various forms of situational exposure (imagined, in vivo, and  role-plays) \nare discussed more thoroughly in chapter 8.\nGradual vs. Rapid Exposure\nExposure may be conducted gradually or rapidly. Rapid exposure involves taking \nsteps very quickly, skipping steps, and sometimes trying more dif\ufb01cult situations before \nyou have completely mastered easier situations. For example, rapid exposure to public \nspeaking might have you start off with talking in front of large groups of unfamiliar \npeople instead of to small groups of familiar people.\nGradual exposure tends to begin with easier practices and progresses to the more \ndif\ufb01cult practices much more slowly. Compared with rapid exposure, a person who is \nworking on gradual exposure may spend more time practicing each step before moving \non to the next level of dif\ufb01culty. In addition, gradual exposure is less likely to leave out \nintermediate steps, compared with rapid exposure. With gradual exposure, by the time \nyou get to the top steps of your hierarchy, you will be better prepared and less likely to \nfeel overwhelmed by the practice.\nGradual exposure is similar to progressing through school one grade at a time. If \nyou had to jump from ninth grade to twelfth grade, you would likely \ufb01nd the increase", "source": "shyness_social.pdf"}
{"id": "926972411e6e-1", "page_content": "in dif\ufb01culty overwhelming. By progressing through high school one grade at a time, you \n\ufb01nd each grade to be just slightly more dif\ufb01cult than the previous grade. By the time \nyou get to twelfth grade, the increase in dif\ufb01culty is only a small step compared with \nyour work in eleventh grade.\nGradual exposure to public speaking might begin by presenting small speeches in \nfront of a close friend or family member or by asking questions at meetings. After those \npractice situations become easier, you might try speaking for longer periods of time \nduring meetings or practicing a speech in front of a small group of friends or family \nmembers. This could then progress to practicing your speech in front of several cowork -\ners. With gradual exposure, you might not actually speak in front of large groups of \nunfamiliar people until many earlier steps have been mastered.\nGradual and rapid exposure are both effective ways of reducing fear, and the end \nresult of each is usually the same. However, each approach has advantages and disadvan -\ntages over the other. With rapid exposure it is likely you will see changes more quickly, \nwhich will save you time. Also, these quick results may motivate you to work even harder \nat overcoming your fear, just as seeing quick changes in your weight or \ufb01tness level can \nmotivate you to stick to an exercise and healthy-eating plan. However, compared with \ngradual exposure, rapid exposure is associated with higher levels of discomfort and fear.", "source": "shyness_social.pdf"}
{"id": "895b81644d6a-0", "page_content": "Confronting Your Fears Through Exposure\n151Rapid exposure requires a strong commitment from you to tolerate higher levels of \ndiscomfort.\nThe differences between these two forms of exposure can be compared to the \ndifference between jumping into a cold swimming pool and entering the pool slowly. \nJumping into the pool quickly causes more initial discomfort, but you get used to the \nwater more quickly. On the other hand, getting into the pool slowly and gradually may \nbe less shocking to your system, but it will take you longer to get used to the water.\nWe recommend that you practice exposures as quickly as you are willing to. If you \nare able to take steps more quickly, you will overcome your anxiety more quickly. If \nyou prefer a more gradual approach, that\u2019s \ufb01ne, too. Sometimes, you may \ufb01nd it dif -\n\ufb01cult to judge whether a particular step is too dif\ufb01cult. Remember, there is no harm in \ntaking steps too quickly. If an exercise ends up becoming too overwhelming, you have \nthe option of continuing to practice it until it becomes easier or stepping back, trying a \nless dif\ufb01cult exercise, and working your way up to the dif\ufb01cult practice more gradually. \nEither approach is likely to be helpful. The decision is a matter of personal preference \nand how much discomfort you\u2019re willing to tolerate.\nHOW EXPOSURE WORKS\nMany cognitive-behavioral researchers and therapists believe that exposure works by \nproviding individuals with an opportunity to test the validity of their fearful thoughts, \nassumptions, and interpretations. In chapter 6, we discussed the use of behavioral experi -\nments for challenging anxious beliefs and predictions. Repeated exposure may be thought \nof as a form of behavioral experiment. By entering feared situations and exposing your -", "source": "shyness_social.pdf"}
{"id": "895b81644d6a-1", "page_content": "of as a form of behavioral experiment. By entering feared situations and exposing your -\nself to feared sensations repeatedly, you will discover whether your beliefs about social \nand performance situations are true or false.\nWhy Exposure May Not Have Worked in the Past\nPeople who are about to begin exposure-based treatments often wonder why they \nshould expect exposure to work now if it hasn\u2019t worked in the past. In all likelihood, \nyou\u2019ve already been exposed to anxiety-provoking social situations from time to time \nand, in many cases, your fear has probably not decreased. In fact, your anxiety may have \nincreased with repeated exposures. Given such previous experiences with exposure, you \nmay be skeptical about whether simply exposing yourself again to feared social situations \nwill lead to a decrease in your fear. \nIt\u2019s important to acknowledge that exposure is not effective under all circumstances. \nFor example, unpredictable exposure can lead to an increase in fear, particularly if it \ninvolves a negative event or consequence. Imagine this situation: You are afraid of dogs \nand a dog unexpectedly runs out from behind a tree and starts growling at you. That \nkind of exposure would only make your fear worse. On the other hand, if you are", "source": "shyness_social.pdf"}
{"id": "10b07ecbd5a8-0", "page_content": "The Shyness & Social Anxiety Workbook\n152 gradually exposed to your neighbor\u2019s friendly dog, at your own pace, your fear of dogs \nmight decrease.\nIn everyday life, exposure to feared situations is often unpredictable. In addition, \nsuch everyday exposures tend to be brief and infrequent. All of these factors make \nexposure in everyday life less likely to lead to a decrease in fear, compared with the type \nof exposure that is used in cognitive-behavioral therapy. A summary of the main differ -\nences between the type of exposure you may have experienced in the past (previous \nexposure) and the type that has been shown as useful for helping people overcome fear \n(therapeutic exposure) appears below.\nTypical Previous Exposures Typical Therapeutic Exposures\nThese are often unpredictable and  \nuncontrollable  (e.g., you \u201cend up\u201d in the \nmiddle of an unexpected conversation; \nyou are \u201cforced\u201d to go to a party that \nyou would rather not attend).These are predictable and under your control  \n(e.g., you make a decision to enter an \nanxiety-provoking situation speci\ufb01cally  \nso that you can learn to be more  \ncomfortable in the situation).\nThese have a brief duration  (e.g., you get \ninto the situation, feel anxious, then  \nleave. This teaches you that when you  \nare in the situation you feel frightened, \nbut when you leave you feel better).These are prolonged  (e.g., you decide to \nstay in a situation until the anxiety comes \ndown on its own or until you learn that \nyour feared consequence doesn\u2019t occur. \nHere, you learn that you can be in the \nsituation, nothing bad happens, and your \nanxiety eventually subsides).", "source": "shyness_social.pdf"}
{"id": "10b07ecbd5a8-1", "page_content": "situation, nothing bad happens, and your \nanxiety eventually subsides).\nThese are infrequent  (e.g., because you \nusually avoid when anxious, you are  \nnot in the feared situation very often. \nEach time you are in the situation, it\u2019s \nlike starting over).These are frequent  (e.g., you practice your \nexposures over and over again and close \ntogether. The bene\ufb01ts of exposures start \nto add up).\nThese usually involve anxious thinking   \n(e.g., \u201cPeople think I\u2019m an idiot,\u201d  \n\u201cPeople will think I\u2019m incompetent  \nif they notice my shaky hands\u201d).These include countering of your anxious \nthoughts  (e.g., you ask yourself questions \nto counter or challenge the anxious \nbeliefs and predictions).\nThese include subtle ways of avoiding  the \nsituation (e.g., by distracting yourself, \nusing alcohol, bringing someone with \nyou, sitting in a certain \u201csafe\u201d location).These do not include subtle avoidance strategies  \n(e.g., you make a decision to not use \nthese strategies so that you teach your -\nself to master the situation on your own).\nAdapted from Antony, M. M. and R. P. Swinson. 2000. Phobic Disorders and Panic in Adults: A Guide to Assessment \nand Treatment . Washington, DC: American Psychological Association. Used with permission.", "source": "shyness_social.pdf"}
{"id": "573bb8244c8d-0", "page_content": "Confronting Your Fears Through Exposure\n153OBSTACLES TO COMPLETING  \nEXPOSURE PRACTICES\nThere are many different reasons why people sometimes don\u2019t follow through on expo -\nsure practices. We suggest that you anticipate the possible obstacles in advance and try \nto think of ways to overcome them. There are always going to be reasons not to practice. \nTo combat the excuses you will undoubtedly come up with, you will need to remind \nyourself of your reasons to continue to practice despite lack of desire, lack of time, or \nbeing overwhelmed with the idea of confronting situations that make you anxious and \nuncomfortable. Here is a listing of some of the most common reasons why people pro -\ncrastinate when it comes to doing exposure exercises. We\u2019ve also offered some possible \nsolutions to these problems.\nObstacle:   My practices are never planned in enough detail, so I am not sure \nexactly what I am supposed to do.\nSolution:   At the beginning of each week, plan your exposure practices thoroughly. \nYou should know exactly what you\u2019re going to do, where you\u2019re going to \ndo it, and when you\u2019re going to practice (dates and times).\nObstacle:   Although I have good intentions, my plans never seem to work out. For \nexample, when I plan to have lunch with a friend, I often \ufb01nd that my \nfriend isn\u2019t available when I call.\nSolutions:   Make sure you make plans early. Leaving things for the last minute will \nmake it much more likely that your plans won\u2019t work out.\nBe sure to have a backup plan. For example, if you\u2019re planning to have \nlunch with a coworker, make sure you have an alternative second plan", "source": "shyness_social.pdf"}
{"id": "573bb8244c8d-1", "page_content": "lunch with a coworker, make sure you have an alternative second plan \nand, sometimes, even a third plan, just in case your friend isn\u2019t available \nfor lunch.\nObstacle:  I always forget to practice.\nSolutions:   Plan your practices the way you would any other activity in your day. \nSet aside blocks of time to practice and record them in your appoint -\nment calendar just as you would for any other appointments, so you \ndon\u2019t forget.\nSet an alarm (e.g., on your wristwatch or a small clock) as a reminder \nto practice.\nAsk other people to remind you, if necessary.\nObstacle:   The idea of doing therapeutic exposure work seems overwhelming. I am \njust too scared.", "source": "shyness_social.pdf"}
{"id": "08a1e00f4513-0", "page_content": "The Shyness & Social Anxiety Workbook\n154Solutions:   Start with an easier practice. The activity that you choose should be \nchallenging but not completely overwhelming. If a particular task seems \nimpossible, start with an easier task that does seem possible.\nUse the cognitive strategies discussed in chapter 6 to challenge your \nanxious thoughts before entering a feared situation.\nObstacle:  I\u2019m too busy. There never seems to be enough time to do the work.\nSolutions:   Put aside small blocks of time to be used exclusively for your social \nanxiety exposure practices. If time is reserved just for this purpose, you \nwill be less likely to feel as if your practices are getting in the way of \nyour other important activities. This is something you want to do for \nyourself. If you really want to deal with your social anxiety, you know \nyou can \ufb01nd the small blocks of time to reserve for the practices. Think \nof practice times as taking a class. You may not always want to go to a \nclass, but if you want to learn what is being taught there, you \ufb01nd the \ntime to go. \nChoose practices that can be completed during the course of your \nregular routine. For example, you need to eat every day\u2014you might as \nwell eat some of your meals with other people instead of always eating \nalone.\nSet aside a large block of time (e.g., clear a week-long vacation from \nwork) and spend the whole time practicing exposure nonstop.\nObstacle:  I am not convinced that exposure practices will be helpful.\nSolutions:   Begin with a smaller exposure practice in which you have little to lose, \nbut in which you can still test whether exposing yourself to the situation \nleads to a decrease in your fear.", "source": "shyness_social.pdf"}
{"id": "08a1e00f4513-1", "page_content": "leads to a decrease in your fear.\nThe belief that exposure won\u2019t work is probably just an example of a \nnegative thought that isn\u2019t necessarily true. Examine the validity of your \nbeliefs regarding exposure. For example, can you think of reasons why \nexposure may not have worked in the past? After you \ufb01nish reading this \nchapter, you may have some new ideas about how to ensure that expo -\nsure will be more likely to work now.\nObstacle:   My feared situations are dif\ufb01cult to create. For example, I can\u2019t think of \nany places to practice public speaking.\nSolutions:   Chapter 8 contains a large number of possible situations in which to prac -\ntice exposure. Reading chapter 8 should help you to generate ideas.\nTalk to family members and friends. They may be able to help you to \ncome up with some ideas for practices.", "source": "shyness_social.pdf"}
{"id": "288278f1cc0f-0", "page_content": "Confronting Your Fears Through Exposure\n155HOW TO CONDUCT EXPOSURE PRACTICES\nThis section provides suggestions for getting the most out of your exposure practices. \nThese include instructions for how to prepare for practices, suggestions to keep in mind \nwhen planning practices, what to do during a particular practice, and what to do follow -\ning the practice. Some of the most important suggestions are summarized in a checklist \nfollowing this section.\nPreparing for Exposure Practices\nAs much as possible, it\u2019s important to plan your exposure practices in advance. As \ndiscussed earlier, planning involves making decisions at the beginning of the week about \nparticular practices that you intend to try, as well as coming up with backup practices in \ncase your original plans don\u2019t work out. It is very likely that planning will involve setting \naside speci\ufb01c times during which to practice. You should also have an idea of how a prac -\ntice \ufb01ts in with your short-term and long-term goals. For example, if your long-term goal \nis to be able to give a presentation to a large group of coworkers, practicing speaking to \nsmaller groups may be an important step in your plan.\nBefore beginning any particular practice, we suggest that you make some very spe -\nci\ufb01c predictions about what might happen during the practice. Once you are aware of \nyour anxiety-provoking thoughts and predictions, use the cognitive strategies described \nin chapter 6 to challenge your thoughts. Challenging your anxious thoughts before \nentering into the situation will help you to manage your fear and discomfort.\nImportance of Predictability and Control\nAs we discussed earlier, exposure works better if it is predictable and if you have a \nsense of control over what\u2019s happening in the situation. Therefore, it\u2019s best to start with", "source": "shyness_social.pdf"}
{"id": "288278f1cc0f-1", "page_content": "exposure practices in which you have a pretty good idea of what is likely to happen. \nSome situations, however, are inherently unpredictable. For example, if you decide to \nask another person out on a date, it may be impossible to know how the other person \nwill respond. In these cases, you can make the situation somewhat more predictable by \nconsidering in advance all of the possible outcomes that could occur. For example, the \nperson might accept your invitation, turn it down, or put off responding for the time \nbeing (for example, by not returning your call or saying, \u201cI\u2019m not sure, let me get back to \nyou\u201d). The person may be warm or may come across as cold or uninterested. By antici -\npating as many outcomes as possible (as well as how you might cope with each outcome), \nyou will be less likely to be surprised.", "source": "shyness_social.pdf"}
{"id": "a94dcab28d4e-0", "page_content": "The Shyness & Social Anxiety Workbook\n156Duration of Exposure\nExposure works better if it lasts long enough for you to learn that your feared \noutcome doesn\u2019t occur. We suggest that you try to stay in the situation for as long as \npossible. For example, if you are at a party, try to stay for at least a couple of hours. If \nyou\u2019re giving a presentation and have the option of making it longer, try to take advan -\ntage of the opportunity to speak for a longer time. Ideally, you should stay in the situ -\nation until your anxiety decreases to a mild or moderate level. However, even if your \nanxiety doesn\u2019t decrease during a particular practice, exposure will still likely be helpful, \nespecially if you don\u2019t leave the situation too quickly.\nIf you are practicing being in a situation that is naturally very brief (something like \nasking a stranger for the time or directions), you can prolong the anxiety-provoking situ -\nation by repeating the exposure over and over for a longer period. For example, instead \nof asking one person for information while walking through a shopping mall (\u201cWhere is \nthe food court?\u201d), you can ask twenty or thirty different people for the same information \nover the course of an hour or more. The chances are good that your fear will decrease \nover time.\nFrequency of Exposure\nExposure works better if practices are repeated close together. For example, giving a \nspeech once a week is more effective than giving a speech once a month. Daily speeches \nwill decrease your fear more effectively than once a week, even if the number of prac -\ntices is the same. In other words, giving a presentation \ufb01ve days in a row will likely lead \nto a greater decrease in fear than giving a presentation once per week for \ufb01ve consecu -", "source": "shyness_social.pdf"}
{"id": "a94dcab28d4e-1", "page_content": "tive weeks. So, try to schedule practices as frequently as possible. We recommend that \nyou set aside at least an hour to practice exposure on most days. Once your fear has \nbegun to decrease considerably, it is a good idea to gradually spread out the practices \nto every few weeks or even to every few months, depending on the situation and how \noften it arises in your day-to-day life. Occasional practices will help to maintain the \n improvements you have made in decreasing your fear.\nPractice in a Variety of Situations\nTo some extent, working on decreasing your fear in a particular social or performance \nsituation will help you to feel more comfortable in other social situations as well. This \nprocess is called generalization , and research has shown that generalization often occurs \nas a result of exposure. For example, if you learn to feel comfortable asking questions \nin class, some of that success may \u201cspread,\u201d or generalize, to other situations, making it \neasier for you to speak up at meetings at work. However, generalization will not cause \nyour success to spread to every situation you fear. Therefore, to get the most out of", "source": "shyness_social.pdf"}
{"id": "b17f763ee519-0", "page_content": "Confronting Your Fears Through Exposure\n157exposure, it\u2019s best to practice in a variety of different contexts, places, and situations. \nFor example, if you want to be more comfortable making small talk, we recommend that \nyou practice with your coworkers, family members, strangers in the elevator, at parties, \nand in as many other situations as possible.\nChoose Practices That Are Challenging but  \nNot Impossible\nYou may feel discouraged if while trying a particular practice, you become anxious \nor uncomfortable. There is no need to feel discouraged. In fact, it is helpful for you to \nfeel some discomfort during exposure practices. That\u2019s why you are doing the practices \nin the \ufb01rst place. Over time, you will begin to feel less anxious. A successful practice is \none that you complete, regardless of how anxious you feel.\nOn the other hand, it\u2019s not necessary to choose practices that are completely terrify -\ning or for which you \ufb01nd it impossible to stay in the situation. If a situation seems too \ndif\ufb01cult, we encourage you to try something easier. But do try something.\nChoose Practices with Minimal Risk\nChoose practices in which the likely consequences are minimal, except for a period \nof feeling anxious. For example, if you want to be more comfortable with the possibility \nof seeming foolish or being the center of attention, there are lots of safe practices that \nyou can try (for example, walking around with your shirt inside out, telling the cashier \nthat you have forgotten your wallet when you reach the front of the grocery line). There \nis no need to take unnecessary risks, such as telling your boss what a jerk he is or yelling \nout a dirty joke at your best friend\u2019s wedding. If you\u2019re not sure about the realistic risks", "source": "shyness_social.pdf"}
{"id": "b17f763ee519-1", "page_content": "associated with a particular practice, ask someone whose judgment you trust (perhaps a \nfriend or family member).\nMeasure Your Improvement\nIt will be helpful to assess your anxiety from time to time using the forms and sugges -\ntions in chapter 3. Evaluating your improvement periodically will remind you of how far \nyou have come and will also let you know when it is time to move on to new situations.\nInclude a Helper or Coach\nConsider including a friend, coworker, or therapist to act as a coach during exposure \npractices. This individual can help you with role-play practices (for instance, a mock", "source": "shyness_social.pdf"}
{"id": "3caef2318aea-0", "page_content": "The Shyness & Social Anxiety Workbook\n158job interview, practicing making small talk) and can provide you with feedback follow -\ning your practices. If you choose to include a helper during some exposure exercises, \nthat person should be familiar with the basic principles of exposure. Either you should \ninstruct the person about what their role as helper or coach entails, or you should have \nthe person read the relevant sections of this book. In fact, some combination of both \napproaches may work best. In addition, the person you choose to work with should be \nsupportive and unlikely to become frustrated if things don\u2019t work out as planned.\nKeep Your Expectations Realistic\nDon\u2019t expect your anxiety to change overnight. It will likely take weeks or months \nfor it to improve. Also, you won\u2019t be able to follow your improvement like a straight line \non a graph. You may \ufb01nd that in some situations your anxiety decreases fairly quickly, \nwhereas in other situations success takes longer. Also, you may \ufb01nd that some exposure \npractices don\u2019t lead to any improvement in your fear. You may even have weeks during \nwhich your fear and anxiety worsen. A good rule of thumb is to expect one step back \nfor every two or three steps forward.\nDon\u2019t Fight Your Feelings\nFor years, you have probably been trying to control your anxiety, to prevent it from \noccurring, and to get rid of it as soon as possible\u2014no matter what the cost. By now, \nyou have probably discovered that trying to control your emotions doesn\u2019t work. In fact, \nattempts to control your anxiety are likely to make it worse rather than better. Fighting \nyour fear is like lying in bed trying hard to fall asleep by a particular time, telling your -", "source": "shyness_social.pdf"}
{"id": "3caef2318aea-1", "page_content": "self, \u201cI must fall asleep!\u201d Often, the more you try to sleep, the harder it becomes. In fact, \nfor some people who have trouble sleeping, trying to stay awake is a productive strategy. \nAs soon as they stop trying  to sleep, they fall asleep quite quickly.\nWhen you can allow yourself to become anxious without \ufb01ghting the feelings, even -\ntually you will become much more comfortable in social and performance situations. \nThis sounds contradictory, but it really works this way. Instead of \ufb01ghting your feelings, \njust let them happen. Instead of evaluating your experiences (for example, \u201csweating in \nfront of others is unacceptable\u201d), accept them. When practicing exposure, you should \nobserve your responses and experiences without evaluating them. Your fear will likely \npass more quickly if you are not trying so hard to get rid of it. Remember, the worst \nthing that can happen is that you will feel uncomfortable for a while. Being anxious is \nnot dangerous, and anxiety always passes.\nAs reviewed in chapter 4, variations of cognitive behavioral therapy have recently \nbeen developed that emphasize the importance of accepting one\u2019s experiences rather \nthan trying to change them. Examples include mindfulness meditation and a form of psy -\nchotherapy called acceptance and commitment therapy (Hayes and Smith 2005).  These", "source": "shyness_social.pdf"}
{"id": "4559d45b6516-0", "page_content": "Confronting Your Fears Through Exposure\n159treatments have been found to be effective for treating certain types of anxiety prob -\nlems, as well as for preventing depression from returning in people who have recently \novercome an episode of depression (Eifert and Forsyth 2005; Orsillo and Roemer 2005; \nWilliams et al. 2007). Learning to accept your uncomfortable feelings rather than \ufb01ght \nthem will ultimately help you to feel more comfortable in the situations you fear.\nEliminate Subtle Avoidance Behaviors\nAs discussed earlier in this chapter, it is important that you stop the subtle avoidance \nstrategies you use to feel safer in social and performance situations. For example, if you \ntend to sit on your hands so people won\u2019t notice them shaking, try letting your hands \nshow. If you avoid talking about yourself when conversing with others, purposely try to \ntalk about your own interests and opinions. For example, mention a book that you\u2019ve \nrecently read or a movie that you\u2019ve seen, and share your opinions. If it\u2019s a best seller \nor a big hit, and you liked it, try to convey your enthusiasm to the person with whom \nyou\u2019re talking; if you didn\u2019t like it, don\u2019t hide your opinion. Express yourself and take a \nchance on engaging in an exciting dialogue.\nEliminating safety behaviors such as overpreparing for presentations, drinking \nalcohol at parties, and wearing makeup to hide blushing will help you to learn that social \nsituations can be managed, even without using these strategies and behaviors.\nEnding a Practice and Moving On to the Next One\nIdeally, an exposure practice should not end before your fear has decreased to a mild", "source": "shyness_social.pdf"}
{"id": "4559d45b6516-1", "page_content": "Ideally, an exposure practice should not end before your fear has decreased to a mild \nor moderate level (such as 20 to 40 on a 0- to 100-point scale). Sometimes, this will take \na few minutes; other times, it may take several hours. If possible, try to stay in the situa -\ntion until you feel more comfortable. However, even if your fear doesn\u2019t decrease within \na practice, you will still likely bene\ufb01t from the practice over the long term.\nIn reality, you may not always have control over when an exposure practice ends. For \nexample, if you\u2019re practicing eating lunch with coworkers during a half-hour lunch break, \nyou may not have the option of stretching the lunch into two hours just to give your \nanxiety a chance to decrease. If the situation ends before your anxiety has decreased, try \nto practice the same situation again as soon as possible. Continue to repeat the practice \nuntil it becomes easier. At that point, you can move on to another practice.\nUsing Exposure Records and Diaries\nTo get the most out of your exposure practices, we suggest that you use the diaries \nand forms provided in chapters 8 and 9 to monitor your progress.", "source": "shyness_social.pdf"}
{"id": "639b3b573f01-0", "page_content": "The Shyness & Social Anxiety Workbook\n160The Aftermath of Exposure: Processing What Happened\nChances are that you will feel good following your exposure practices. Although \nyou may be tired, you likely will also feel relieved to have completed the practice and \nproud of your accomplishments. Nevertheless, some people tend to analyze their every \nmove and criticize their performances during the practice (for example, \u201cPeople surely \nnoticed my anxiety,\u201d \u201cI came across like a bumbling idiot\u201d). If you tend to dwell on what \nhappened during your practices, we suggest that you try to put a more positive spin on \nthe experience.\nRemember that the main reason you are practicing exposure is to eventually  feel \nmore comfortable in social and performance situations. However, for now, expect to \nfeel uncomfortable during practices. Expect that your performance won\u2019t be perfect (in \nfact, the goal isn\u2019t perfection anyway). Rather than dwelling on what happened or didn\u2019t \nhappen, try to use the cognitive techniques from chapter 6 to challenge your negative \nthinking. Also, try to take something positive from the experience. Even if things didn\u2019t \ngo the way you had hoped they would, you can still use the experience to plan future \npractices and to generate ideas for what you might do differently the next time.\nA WORD TO SIGNIFICANT OTHERS, FRIENDS, \nAND FAMILY MEMBERS\nIf you are reading this book in order to help a loved one, here are a few suggestions to \nkeep in mind. First, your loved one must be on board with this treatment. Treatment is \nnot something that can be forced on someone who isn\u2019t willing to make the necessary \nchanges. In addition, you should avoid the temptation to trick, force, bribe, or coerce", "source": "shyness_social.pdf"}
{"id": "639b3b573f01-1", "page_content": "a person into doing exposure practices. In order to get the most out of treatment, it\u2019s \nimportant that the decision to do exposure comes from the individual.\nYour role in exposure therapy is to help brainstorm possible exposure practices, \nto provide support, to participate in exposure role-plays (for example, a simulated job \ninterview), and to be involved in actual exposure practices when you\u2019re asked to do so. \nFor example, if your loved one fears attending parties, he may ask you to attend a party \nwith him. If your loved one fears eating in restaurants, she may ask you to join her for \na meal. In advance of any exposure practices, discuss with your loved one what he or \nshe would like you to do in the situation (for example, provide reassurance, provide \ncompany, probe for anxiety-provoking thoughts, and so on).\nSUMMARY OF EXPOSURE GUIDELINES\nThis chapter described a long list of guidelines for how to get the most out of your expo -\nsure practices. Following is a list of the most important suggestions, in summary form.", "source": "shyness_social.pdf"}
{"id": "acb0df79b55f-0", "page_content": "Confronting Your Fears Through Exposure\n161U\u00caPlan practices in advance. Set aside time to practice exposure.\nU\u00caExposure practices should be predictable and under your control (particu -\nlarly early in treatment).\nU\u00caExposure should be frequent (almost daily), especially at the start.\nU\u00caExposure should be prolonged. Try to stay in the situation until your fear \nhas decreased.\nU\u00caUse cognitive strategies to challenge anxious thoughts before entering the \nsituation.\nU\u00caUse cognitive strategies to challenge anxious thoughts during the practice.\nU\u00caUse cognitive strategies to challenge anxious thoughts after leaving the \nsituation.\nU\u00caDon\u2019t \ufb01ght your anxious feelings in the situation. Just let the feelings \nhappen.\nU\u00caEliminate subtle avoidance strategies like distraction, alcohol use, and over -\nprotective behaviors.\nU\u00caPractice in a number of different situations.\nU\u00caChoose practices in which the actual risk is minimal, especially at \ufb01rst.\nU\u00caChoose practices that are challenging, but not impossible.\nU\u00caComplete exposure records (see chapters 8 and 9) with each practice.\nTROUBLESHOOTING\nProblem:  My fear does not decrease during my exposure practices.\nSolutions:   This is normal to some extent. Although anxiety and fear usually decrease \nduring the course of a particular exposure practice, most people experi -\nence occasional practices in which their anxiety doesn\u2019t decrease. Here \nare some suggestions for dealing with this situation.\nMake sure that you are staying in the situation long enough. Sometimes \nit can take several hours for a person\u2019s fear to diminish.\nMake sure that you are not using subtle avoidance strategies. The \nnormal pattern during exposure is for fear to increase and then gradu -", "source": "shyness_social.pdf"}
{"id": "acb0df79b55f-1", "page_content": "normal pattern during exposure is for fear to increase and then gradu -\nally to decrease. Using subtle avoidance strategies such as distraction", "source": "shyness_social.pdf"}
{"id": "59e34ba092f4-0", "page_content": "The Shyness & Social Anxiety Workbook\n162may cause the fear to go up and down repeatedly over the course of the \npractice, because most people are not very good at distracting them -\nselves for long periods.\nNegative thinking can sometimes interfere with the effects of exposure. \nIf your fear does not decrease during a particular exposure practice, \nchallenge your anxious thoughts using the techniques described in \nchapter 6.\nIf all else fails, just keep practicing. Sometimes it takes repeated expo -\nsure practices before a person\u2019s fear begins to lessen.\nProblem:  My fear returns between exposure practices.\nSolution:   This is normal for most people. With more and more practice, your \nfear will decrease more quickly during practices and will not return as \nintensely between them. One way of preventing your fear from return -\ning between exposures is to increase the frequency of your practices, \nparticularly early in treatment.\nProblem:   My physical symptoms (for instance, stuttering, shaking, sweating) are \nvery noticeable.\nSolution:   Remember that, despite how it seems to you, the chances are good that \nyour symptoms are not as noticeable to others as you think they are. \nFurthermore, as your anxiety decreases, the intensity of these symp -\ntoms will likely decrease. If you are concerned about people noticing \nyour symptoms, use the cognitive techniques from chapter 6 to chal -\nlenge your anxious thinking. Remember that there are lots of people \nwho blush, shake, or lose their train of thought and who couldn\u2019t care \nless about what other people think. The problem is not that you experi -\nence these symptoms, but rather your beliefs about the consequences \nof having these symptoms.\nProblem:   I am just not good at             (making small talk, \npublic speaking, and so on).", "source": "shyness_social.pdf"}
{"id": "59e34ba092f4-1", "page_content": "public speaking, and so on).\nSolution:   Your social skills are likely much better than you think they are. As \ndiscussed in earlier chapters, people who are socially anxious tend to be \noverly critical of their social and performance skills. Nevertheless, there \nmay be ways in which certain skills can be improved. It is likely that \nexposure alone will contribute to an improvement of your skills. For \nexample, practicing making small talk will help you to learn what works \nduring a casual conversation and what doesn\u2019t. In addition, we suggest \nthat you read chapter 10, which includes speci\ufb01c strategies for improv -\ning social and communication skills.", "source": "shyness_social.pdf"}
{"id": "17a4ddcc2948-0", "page_content": "Confronting Your Fears Through Exposure\n163Problem:  My fear is too high to bene\ufb01t from exposure.\nSolutions:   Ideally, you should choose practices that arouse a fear level of 70 to \n80 out of 100, although it is also okay if your fear reaches even higher \nlevels. One method for keeping your fear in check is to use the cog -\nnitive strategies from chapter 6 to challenge your anxious thoughts \nbefore entering the situation. At times, however, even using the cogni -\ntive techniques beforehand won\u2019t prevent your fear from becoming very \nintense. \nIf you \ufb01nd that your fear is completely overwhelming, you have three \noptions. First, you can try to wait a while longer to see if your fear \ndecreases. Alternatively, you may consider taking a short break and \nthen trying the same exercise again. Finally, you can try switching to a \nless dif\ufb01cult practice. Any of these approaches is usually \ufb01ne. The main \npoint is not to give up completely.\nProblem:   The situations that I fear are very brief in duration, so there isn\u2019t enough \ntime for my fear to decrease.\nSolution:   This issue was discussed earlier in the chapter, but it\u2019s worth highlight -\ning again here. Ideally, if an exposure practice is brief, you should try \nto \ufb01nd creative ways to lengthen the duration of the practice, if pos -\nsible. For example, if you are fearful of chatting with the cashier at the \nfront of a supermarket line, try lining up repeatedly over the course of \nan hour or two and buying only a few items at a time. This approach \nwill give you more opportunities to talk to the cashiers, compared with \npaying for all your groceries at once.", "source": "shyness_social.pdf"}
{"id": "17a4ddcc2948-1", "page_content": "paying for all your groceries at once.\nProblem:   I just had something terrible happen during an exposure practice (for \nexample, my boss criticized my presentation). How can I ever try expo -\nsure again?\nSolutions:   Although rare, it is possible that an unexpected negative event will \noccur during an exposure practice. For example, you could experience \na bad panic attack during a job interview, or you may be laughed at \nduring a presentation. If something bad does happen during an expo -\nsure practice, it\u2019s natural for some of your fear to return. It may be \nhelpful to \u201crethink\u201d the meaning of the negative event using the cogni -\ntive techniques described in chapter 6. In addition, we recommend that \nyou resume your exposure practices. If necessary, you can return to a \nprevious item in your hierarchy and work your way back to where you \nwere when the unfortunate incident took place.", "source": "shyness_social.pdf"}
{"id": "8d1baa50858e-0", "page_content": "The Shyness & Social Anxiety Workbook\n164Problem:  I don\u2019t avoid the situation, and yet my fear persists.\nSolutions:   Although exposure usually leads to a decrease in fear, occasionally \npeople report having intense fear in social situations despite almost \nnever avoiding these situations. For example, a person may eat with \nothers on a regular basis but still get anxious in the situation. If you \ncontinue to experience fear, despite never avoiding the feared situation, \nyou may \ufb01nd it dif\ufb01cult to come up with appropriate exposure exercises. \nHere are three strategies to consider. \nFirst, if you fear experiencing arousal symptoms while in social situa -\ntions, try the interoceptive exposure exercises discussed in chapter 9. \nSecond, assess whether you are engaging in subtle avoidance strategies, \noverprotective behaviors, alcohol or drug use, or other strategies that \nmay be undermining the effects of the exposure. If so, try to discontinue \nthese behaviors. Finally, a special effort should be used to identify and \nchallenge the anxious predictions and beliefs that continue to maintain \nyour fear (see chapter 6).", "source": "shyness_social.pdf"}
{"id": "44e746cfc162-0", "page_content": "CHAPTER 8\nExposure to Social Situations\nIn chapter 7, we provided an overview of the basic principles underlying exposure-based \ntreatments for social anxiety. In this chapter, we\u2019ll present additional information about \nhow to use these strategies to confront the social and performance situations that make \nyou anxious or uncomfortable. You should be very familiar with the material in chapter \n7 before moving on to this chapter. As noted earlier, we suggest that you use the cogni -\ntive strategies described in chapter 6 to combat anxious thinking before, during, and \nafter exposure practices. During practices, you should refrain from using subtle avoid -\nance techniques such as distraction, drugs or alcohol, and safety behaviors (for example, \neating in a dimly lit restaurant so people don\u2019t notice your blushing). Finally, a reminder \nthat exposure works best when practices are:\nU\u00caFrequent (daily, if possible)\nU\u00caProlonged (until the anxiety decreases)\nU\u00caPredictable and controllable\nU\u00caPlanned in advance\nU\u00caConducted in a variety of different situations\nSITUATIONAL EXPOSURE PRACTICES\nThis section provides suggestions for exposure practices involving different types of \nsocial and performance situations, including public speaking, making small talk, meeting \nnew friends and dating, situations involving con\ufb02ict with others, being the center of", "source": "shyness_social.pdf"}
{"id": "19ef2ba3cc08-0", "page_content": "The Shyness & Social Anxiety Workbook\n166attention, eating and drinking in public, writing in front of others, job interviews, being \nin public, and talking to people in authority. In addition to the suggestions provided \nhere, there is space in each section for you to record additional ideas for practices that \nmight be relevant to your own social and performance anxiety. \nAt \ufb01rst, many of the items suggested in this section may seem overwhelming. \nHowever, as suggested in chapter 7, you should begin with challenging but manageable \npractices. Over time, you will become more comfortable and most likely you will be able \nto try some of the more dif\ufb01cult practices. In addition, some of these practices may seem \nvery easy to you. If you have no trouble with a particular type of social or performance \nsituation, there is no need to practice confronting it. Instead, focus on the situations that \nare anxiety-provoking for you.\nPractices Involving Public Speaking\nTo overcome a fear of speaking in front of others, it is helpful to take advantage of \nopportunities that come up during the course of your job or other activities in your day-\nto-day life. If public speaking opportunities don\u2019t normally arise in your life, there are \nmany ways of creating these situations. Some of these include the following:\nU\u00caSpeak up in meetings at work . For example, share your opinions about \nissues being discussed. Ask and answer questions. If the opportunity to \nmake a brief presentation arises, take advantage of it.\nU\u00caOffer to give a presentation at work or in another situation . For example, \nif you belong to a book club or reading group, offer to present a summary \nof the book that your group is reading. If you have some special expertise,", "source": "shyness_social.pdf"}
{"id": "19ef2ba3cc08-1", "page_content": "of the book that your group is reading. If you have some special expertise, \noffer to share it with your coworkers, colleagues, or friends by giving a \nformal presentation.\nU\u00caGo to a public lecture and ask questions . Public lectures are often adver -\ntised in the newspaper, on the Internet, on the radio, or on television (for \nexample, on your local cable access channel). Also, check out advertisements \non community bulletin boards and posters at the library, supermarket, local \ncolleges, or other public places.\nU\u00caTake a course at a college, university, or any school that offers adult \neducation courses . Try to choose courses that provide the opportunity to \ngive presentations. If these are not available, make a point of asking ques -\ntions several times during each class. If you are unable to enroll in a course, \nanother option is to simply audit or sit in on a large class at a local univer -\nsity. Professors will sometimes give guests permission to observe a class \nwithout formally enrolling. Often, undergraduate classes contain hundreds \nof students, so no one would notice an extra person in the room. Auditing", "source": "shyness_social.pdf"}
{"id": "f5cc0263d4ad-0", "page_content": "Exposure to Social Situations\n167a large class will save you from having to pay registration fees while still \nproviding you with an opportunity to ask questions in public.\nU\u00caMake an impromptu speech or toast at a wedding, party, group dinner, \nor other social gathering . If you are invited to a party or are planning to \nhave a party of your own, offer to make a short speech in front of the other \nguests.\nU\u00caTake a public speaking course . There are numerous companies that offer \npublic speaking courses (especially for businesspeople). These classes are \nsometimes expensive, but it may be worth \ufb01nding out more about the avail -\nable options (perhaps your workplace would help to cover the costs). Check \nthe Internet or your local Yellow Pages to learn about courses. There are \nmany options available, including, for example, courses by Dale Carnegie \nTraining (www.dalecarnegie.com) and The Leader\u2019s Institute (www.leaders  \ninstitute.com).\nU\u00caJoin Toastmasters International . Toastmasters is an organization that holds \nmeetings for individuals who are interested in learning to speak more effec -\ntively in front of others. They have more than 11,000 clubs located in ninety \ncountries around the world. Typically, groups include about twenty indi -\nviduals who meet for one to two hours each week. Annual membership is \ninexpensive. For more information, visit www.toastmasters.org.\nU\u00caTake a drama or music class . Taking a theater, drama, or music class will \nprovide you with opportunities to perform in front of others. Classes may \nbe available at local high schools or colleges, professional theater or music \nschools, the YMCA, or through other agencies.", "source": "shyness_social.pdf"}
{"id": "f5cc0263d4ad-1", "page_content": "schools, the YMCA, or through other agencies.\nU\u00caGive a lecture at a local elementary school, high school, or college about \nyour work . Sometimes schools will hold career days through which students \nhave opportunities to learn about particular jobs or careers. Additionally, \nteachers sometimes invite guests to speak to their classes about particu -\nlar types of careers or jobs. Call a local school principal to \ufb01nd out about \nopportunities in your neighborhood school. Or, if you have a child in school, \nyou may have the opportunity to speak to his or her class about what you \ndo at work.\nU\u00caRead a passage in front of others . For some people, reading a newspaper \narticle or a passage from a book in front of a few family members may \nbe anxiety provoking. For others, it may be important to try something \nmore challenging, such as reading an introduction for a guest speaker who \nis about to give a presentation at your workplace.", "source": "shyness_social.pdf"}
{"id": "ff8479d4fbd7-0", "page_content": "The Shyness & Social Anxiety Workbook\n168Now, can you think of other possible practices that involve public speaking? If so, \nrecord them in the space below:\nOther Practices\nPractices Involving Making Small Talk, Casual \nConversation, and Informal Socializing\nCasual conversation and small talk can take place anywhere. The list below provides \na few examples of situations where you might have the opportunity to practice these \nskills. In addition to planning several large practices per week, you should try to engage \nin several mini-practices throughout the day.\nU\u00caHave friends over for a get-together . For example, invite several cowork -\ners over for dinner or to watch a movie or sports event on TV. Or, have a \nbirthday party for a friend or family member. Make sure that you interact \nwith your guests! Don\u2019t come up with excuses to avoid them (like serving \nfood and drinks to the exclusion of conversation, cleaning up, or washing \nthe dishes).\nU\u00caSpeak to strangers on elevators, while waiting in lines, at bus stops, or \nat other public locations . With repeated practice, making small talk will \nbecome easier. Prolonged exposure works best, so try to talk to many dif -\nferent people over the course of an hour or two to get the most bene\ufb01t. \nSmile, say hello, and use humor, if appropriate. Although you should be \nprepared for some people to react negatively (remember, other people may \nalso be shy or they may be uninterested in making small talk), most people \nwill probably react positively.\nU\u00caAsk for directions or for the time . Walk up to a stranger in a mall or store \nand ask what time it is. Or, ask how to \ufb01nd a particular location. As men -", "source": "shyness_social.pdf"}
{"id": "ff8479d4fbd7-1", "page_content": "tioned earlier, prolonged exposure works best, so try to do this repeatedly \nover an hour or two or until your anxiety decreases.\nU\u00caTalk to coworkers or classmates . Try arriving at school or work a bit early \nso that you will have the opportunity to chat with others. Make a point of \nsaying hello to your coworkers or classmates during breaks. Simple ques -\ntions such as, \u201cHow was your weekend?\u201d are often a great way to get a \nconversation started.", "source": "shyness_social.pdf"}
{"id": "ecc9e2099cef-0", "page_content": "Exposure to Social Situations\n169U\u00caTalk to dog owners who are walking their dogs . Dog owners often love to \ntalk about their dogs. If you have a dog, try going for walks in areas where \nother people walk their pets. Make comments or ask questions about other \npeople\u2019s dogs (for example, \u201cNice dog\u201d or \u201cWhat kind of dog is that?\u201d). If \nyou return to the same routes frequently, you will likely see the same people \nover and over again. You may even make some new friends.\nU\u00caTalk to cashiers or other staff personnel in stores . For example, comment \non the weather, ask for advice or information (\u201cDoes this shirt go with these \npants?\u201d), or special order a book or CD.\nU\u00caGive or receive compliments . Offer someone else a compliment. For \nexample, tell a coworker that you like her sweater or new haircut, tell an \nartist that you like his work, or compliment a waiter on the quality of your \nfood. If you are uncomfortable receiving compliments, just say \u201cThank you\u201d \nwhen someone praises you. Don\u2019t discount the praise by telling the person \nall the reasons why you don\u2019t deserve it.\nU\u00caExpress a controversial opinion . If you have a controversial opinion about \nsome issue, express it, particularly in situations where the consequences are \nlikely to be minimal. For example, if you didn\u2019t like a movie that someone \nelse is raving about, let them know what you didn\u2019t like about the \ufb01lm. If \nyou disagree with someone else\u2019s political views, explain your perspective \non the issue. Try not to put down the other person or to discount that \nperson\u2019s views when you are expressing your own opinions. Differing views", "source": "shyness_social.pdf"}
{"id": "ecc9e2099cef-1", "page_content": "person\u2019s views when you are expressing your own opinions. Differing views \nshould be expressed in a friendly and supportive way, and you should make \nan effort to communicate understanding of the other person\u2019s perspective.\nU\u00caJoin an ongoing conversation . In some circumstances, it is perfectly appro -\npriate to join an ongoing conversation. For example, at parties people often \nwalk about, moving in and out of different conversations. See if you can join \nin with a group of people who are discussing some issue that interests you.\nU\u00caTalk to parents of other children . Just as pet owners enjoy talking to other \npet owners, parents usually enjoy talking about their children with other \nparents. If you have children, get involved in situations where you might \nhave the opportunity to talk to other parents. For example, attend parents\u2019 \nnight at your children\u2019s school or enroll your children in a class (such as \nswimming, hockey, crafts, music) with other children. Take advantage of any \nopportunities to talk to the other parents.\nU\u00caMeet two or three friends at a caf\u00e9 . Invite several coworkers or friends to \nmeet you after work or school for a coffee, drink, or snack. Alternatively, \ninvite others to join you for lunch.", "source": "shyness_social.pdf"}
{"id": "366eef16a7cf-0", "page_content": "The Shyness & Social Anxiety Workbook\n170Can you think of other possible practices that involve informal socializing, casual \nconversation, or making small talk? If so, record them in the space below:\nOther Practices\nPractices Involving Meeting New Friends and Dating\nMany of the situations listed in the previous section on practices involving small \ntalk and casual conversation also provide opportunities to meet new people. Similarly, \nseveral of the situations listed in this section also provide opportunities for casual con -\nversation. Most new friendships and relationships start with a casual conversation, so it\u2019s \nno surprise that these sections might overlap. Also, developing new relationships often \nrequires repeated encounters with new people you meet. In other words, two people \nwill typically become acquaintances before they become friends. The list below provides \nexamples of practices that involve a possibility of meeting new people, developing new \nfriendships, developing new business relationships, or fostering opportunities for dating. \nRemember that the main goal of an exposure practice should be to become more com -\nfortable in these situations. For now, developing new relationships should be a secondary \ngoal. Focus on the process of reducing your fear rather than whether you develop new \nfriends or relationships through these practices.\nU\u00caGo to a social event . For example, attend your annual of\ufb01ce holiday party, \na class reunion, a community dance, a local art gallery opening, or a book \nsigning. Situations such as these will provide you with opportunities to meet \npeople, as well as to mingle and make small talk. Be sure to take social risks \nin these situations (for example, talking to other people).\nU\u00caTalk to your neighbors . Go for walks in the neighborhood and say hello \nto your neighbors\u2014particularly those you have not had a chance to meet.", "source": "shyness_social.pdf"}
{"id": "366eef16a7cf-1", "page_content": "to your neighbors\u2014particularly those you have not had a chance to meet. \nIf you have a new neighbor, consider asking him or her over for a drink or \ndessert. Invite some of your other neighbors as well.\nU\u00caJoin a club, take a class, or join an organization . For example, join a bowling \nleague, aerobics class, volleyball league, bingo group, self-help group, church \ngroup, art class, or other group. Ideally, the group should meet frequently \n(for instance, weekly) for you to get the most bene\ufb01t from attending it.", "source": "shyness_social.pdf"}
{"id": "302bc6ac9d2f-0", "page_content": "Exposure to Social Situations\n171U\u00caAsk friends or colleagues to introduce you to new people . Take advantage \nof opportunities to meet new people through friends, coworkers, or other \npeople you know.\nU\u00caInvite people you know to socialize . For example, invite several coworkers \nor acquaintances for lunch, dinner, a movie, or a concert. Or, invite several \ncoworkers or acquaintances away on a vacation, ski weekend, or conference-\nrelated trip.\nU\u00caMeet people through online social networks or dating services . Consider \njoining an online social networking site, such as Facebook (www.facebook  \n.com) or MySpace (www.myspace.com). Join online chat rooms. Meet \npeople through online dating services (for example, www.match.com). Two \ncautions: \ufb01rst, although the Internet can be a useful tool for meeting people, \nit\u2019s important that you not rely exclusively on online relationships instead  \nof in-person relationships. Rather, consider using the Internet as a tool for \nmeeting people who you might eventually meet in person. Second, if you \nare meeting people in person for the \ufb01rst time, use appropriate caution. For \nexample, a \ufb01rst date should happen in a public place, and you should not \ngive others your home address until you know them fairly well.\nU\u00caArrange for dates through personal ads or dating services . In addition \nto meeting people through the Internet, you can also \ufb01nd opportunities \nfor dating through professional dating services and through personal ads in \nlocal newspapers.\nCan you think of other possible practices that involve meeting new friends, dating, \nor related situations? If so, record them in the space below:\nOther Practices\nPractices Involving Possible Con\ufb02ict with Others", "source": "shyness_social.pdf"}
{"id": "302bc6ac9d2f-1", "page_content": "Other Practices\nPractices Involving Possible Con\ufb02ict with Others\nThese practices should be planned carefully. Unlike the other practices recom -\nmended in this chapter, these are likely to cause another person to become a bit angry \nor impatient with your behavior. Choose practices in which the risks are minimal\u2014if you \nare unsure of the risks, ask a friend or family member for a second opinion. You may also", "source": "shyness_social.pdf"}
{"id": "751937c22f57-0", "page_content": "The Shyness & Social Anxiety Workbook\n172want to skip ahead to the sections on assertive communication in chapter 10 to prepare \nyourself for this kind of interaction. It\u2019s important that potential con\ufb02ict situations be \ndealt with assertively rather than with aggression, which is likely to escalate the other \nperson\u2019s anger.\nIt may seem rude to do things purposefully that will inconvenience others. On the \nother hand, as you continue to read this section, you will see that most of these practices \ninvolve only minor inconvenience to other people, and many of these are situations that \npeople often encounter anyway. The substantial gains that you may obtain from these \npractices are likely to outweigh any inconvenience that you create for others.\nListed below are some examples of practices that others have found useful for \nbecoming more comfortable with con\ufb02ict situations:\nU\u00caAsk someone else to change his or her behavior . For example, ask your \nroommate to wash his or her dishes rather than leaving dirty dishes lying \naround. Or, ask another person to stop talking in a movie theater.\nU\u00caStay stopped in your car for a few seconds when the light turns green . \nPretend you are changing the radio station or that you didn\u2019t notice the \nlight turn green. The drivers who are backed up behind you eventually may \nbecome frustrated and honk their horns. This should be your signal to drive \naway.\nU\u00caSay no when you don\u2019t want to do something . If someone asks you to do \nsomething that you don\u2019t want to do (for example, donate money that you \ncan\u2019t afford, purchase an item from a telemarketer, do more than your fair", "source": "shyness_social.pdf"}
{"id": "751937c22f57-1", "page_content": "share of work, and so on), say no in an assertive (though polite) way. Again, \nwe recommend that you read chapter 10 for suggestions regarding assertive \ncommunication.\nU\u00caReturn an item to a store . Return a book, an article of clothing, or some \nother item to a store. In most cases, the staff at the store will gladly take \nback the item. However, sometimes you may encounter a negative response, \nwhich will provide you with the opportunity to get used to this uncom -\nfortable situation. To really test yourself, try to return an item without \na receipt, without the original packaging, or after the allowed period for \nreturns has passed. The store may not take back the item, but you will get \nan  opportunity to practice dealing with possible con\ufb02ict.\nU\u00caSend food back in a restaurant . Ask your server to take your food back (for \ninstance, to change the dressing on your salad, make your soup hotter, cook \nyour food more thoroughly, or bring you a different drink).\nU\u00caTake an extra long time at a bank machine when there are people waiting \nbehind you . For example, make several deposits, transfer funds from one", "source": "shyness_social.pdf"}
{"id": "e75abafb507e-0", "page_content": "Exposure to Social Situations\n173account to another, and withdraw cash from two or more different accounts. \nMake eye contact with others in line to see if they are looking impatient.\nU\u00caForget your money when paying for an item in a store . For example, when \nyou reach the front of a supermarket line, tell the cashier that you have \nforgotten your wallet. Or, have more items in your cart than you can afford \nto purchase. This will help you to better tolerate the possibility of inconve -\nniencing the cashier and the people in line behind you.\nU\u00caAsk a stranger to stop smoking . If you are in a restaurant or bar, or even in \na public place outdoors, try asking the person next to you to stop smoking. \nUse some discretion. For example, don\u2019t practice this if the other person \nseems aggressive, likely to get angry, or is much bigger than you are.\nNow, can you think of other possible practices that involve some risk of mild con -\n\ufb02ict? If so, record them in the space below:\nOther Practices\nPractices Involving Being the Center of Attention\nHere are some suggestions for ways to draw attention to yourself. If you are afraid \nof looking foolish, standing out in a crowd, or simply being observed by others, try some \nof these exercises:\nU\u00caSay something incorrectly . Purposefully answer a question incorrectly in class, \nprovide someone with incorrect information, or mispronounce a word.\nU\u00caSpeak loudly . Speak loudly in a public place (for example, at a mall, in a bus, \nor on the subway), so that others around you can hear your conversation.\nU\u00caHave a mobile phone or pager go off in a public place . Arrange for someone", "source": "shyness_social.pdf"}
{"id": "e75abafb507e-1", "page_content": "to page you or call you on your cell phone while you are at the dentist, eating \nat a restaurant, or walking through a public place. Use some discretion here. \nFor example, don\u2019t try this practice during a college exam, a job interview, or \nwhile at a movie, unless your intention is to annoy the people around you.\nU\u00caDrop something . Drop your keys, your books, or some other item in a \npublic place. Or, spill water all over your shirt.", "source": "shyness_social.pdf"}
{"id": "d17505870683-0", "page_content": "The Shyness & Social Anxiety Workbook\n174U\u00caTalk about yourself.  When speaking with other people, talk about your \nfamily, your job, your hobbies, or some other aspect of your personal life. \nOffer your opinions about political issues, books that you have read recently, \nor movies that you have seen.\nU\u00caParticipate in a party game . For example, play Twister, Pictionary, \nScattergories, Outburst, Trivial Pursuit, or some other game with friends, \ncoworkers, or your family.\nU\u00caWear your shirt or dress inside out or backward . Walk around a public \nplace while making a fashion faux pas. The more outrageous, the better. \nFor example, wear shoes that don\u2019t match. Wear a plaid shirt with striped \npants. Wear your dress or shirt inside out (this exercise is even better if your \ndress or shirt has shoulder pads), or wear a formal evening gown during the \nday. With practice, you will become much less concerned about looking \nconspicuous.\nU\u00caKnock over a display in a store . For example, knock over a few rolls of \npaper towels or toilet paper in the supermarket. Again, it is important to use \ngood judgment. For example, don\u2019t knock over glass jars of tomato sauce. \nThat would be going too far!\nNow, can you think of other possible practices that involve being the center of \nattention? If so, record them in the space below:\nOther Practices\nPractices Involving Eating or Drinking with Others\nPeople who fear drinking in front of others are often concerned about having shaky \nhands and spilling their drinks. Those who are fearful of eating in front of others may be", "source": "shyness_social.pdf"}
{"id": "d17505870683-1", "page_content": "nervous about making a mess, looking unattractive while eating, or feeling \ufb02ushed from \neating hot foods. You should choose to practice exposure in situations that will challenge \nyour speci\ufb01c anxieties. For example, if you are more anxious when eating messy foods, \nyou should order foods that are more likely to be messy. If you\u2019re nervous about blushing \nor sweating, order hot soup or a spicy meal. A list of situations offering an opportunity \nto eat or drink in front of others is provided here:", "source": "shyness_social.pdf"}
{"id": "4f484e3ebaff-0", "page_content": "Exposure to Social Situations\n175U\u00caEat a snack at your desk. If your desk at work is in an open area, eat a snack \nat your desk. This may be easier than eating with your coworkers. When \nthis exercise becomes easier, you can move to other practices, such as those \nin the rest of this list.\nU\u00caHold a drink at a party or gathering . If you tend to be anxious when holding \na glass of wine or a soft drink in front of others, try doing just that the next \ntime you\u2019re at a party or other social gathering. Try not to hide your hands \nif they begin to shake. If alcohol tends to decrease your anxiety, make sure \nyou don\u2019t drink wine, beer, or spirits until after your anxiety has decreased \non its own.\nU\u00caHave lunch with coworkers . You probably eat lunch every day. You might \nas well eat with other people, if the opportunity arises. If your natural ten -\ndency is to eat at your desk or to eat lunch in restaurants alone, invite a \ncoworker to join you for lunch once or twice every week.\nU\u00caMeet a friend at a restaurant for dinner . If you tend to feel safer in dark \nrestaurants, challenge yourself by choosing a more brightly lit location. Try \nto choose a seat where you are more likely to be observed by the other \npeople in the restaurant.\nU\u00caInvite people over for a meal . For example, invite two or three friends or \nneighbors over for dinner.\nU\u00caDine at other people\u2019s homes . If you tend to decline invitations to eat at \nother people\u2019s homes, accept the invitation next time. You may \ufb01nd it more \ndif\ufb01cult to do so if you are concerned about not being able to control the", "source": "shyness_social.pdf"}
{"id": "4f484e3ebaff-1", "page_content": "dif\ufb01cult to do so if you are concerned about not being able to control the \nenvironment (such as the lighting), who the other guests are, and what types \nof food are served, but don\u2019t use these as reasons to avoid the situation.\nU\u00caDine alone in a restaurant, food court, or another public place . If eating \nalone in public makes you anxious, having lunch alone in a restaurant or \nfood court is an appropriate practice. You might also want to consider eating \nin other public places, such as sitting on a bench in a park or in a shopping \nmall.\nCan you think of other possible practices that involve eating or drinking in front of \nothers? If so, record them in the space below:\nOther Practices", "source": "shyness_social.pdf"}
{"id": "f428f4e096ae-0", "page_content": "The Shyness & Social Anxiety Workbook\n176Practices Involving Writing in Front of Others\nAs a rule, people who are uncomfortable writing in front of others are concerned \nabout having shaky hands while they are writing. They also may be fearful of others \njudging their handwriting or noticing personal information that they may be record -\ning. Examples of situations that can provide an opportunity to write in front of others \ninclude the following:\nU\u00caPay for items using a check . Instead of paying with cash or a debit card, \nwrite a check when purchasing merchandise in a store. Be sure to complete \nthe check in front of the cashier (don\u2019t write out the check before you get \nto the store: that\u2019s cheating). If you\u2019re concerned about having the cashier \nnotice your shaky hands, try making your hands shake purposefully. In fact, \nto really challenge your fear, let your hands shake so much that you have to \nwrite a whole new check.\nU\u00caWrite a letter while seated in a public place . Write a letter to a friend while \nsitting in a caf\u00e9, riding on a bus, or relaxing on a public bench. Make sure \nthat there are others around who can see you writing.\nU\u00caFill out forms or applications in front of other people . For example, com -\nplete an application for a new credit card or loan at a bank (with the bank \nof\ufb01cer watching), complete an application for a new video-store member -\nship, \ufb01ll out a contest ballot in front of a cashier, or sign documents in front \nof your coworkers.\nCan you think of other possible practices that involve writing in front of other \npeople? If so, record them in the space below:\nOther Practices\nPractices Involving Job Interviews", "source": "shyness_social.pdf"}
{"id": "f428f4e096ae-1", "page_content": "Other Practices\nPractices Involving Job Interviews\nTo become more comfortable with job interviews, the best exposure practices are \nthose that provide experiences similar to real job interviews. Some examples include:\nU\u00caApply for a volunteer position.  Many volunteer opportunities (for example, \nin hospitals, schools, theater companies, charitable organizations,  community", "source": "shyness_social.pdf"}
{"id": "ab78ffbdfe46-0", "page_content": "Exposure to Social Situations\n177agencies, and so on) begin with an interview process that is very similar to \nan interview for a paying job. You may feel less pressure if you know that \nyou\u2019re applying for a nonpaying position. If so, this would be a good place \nto start. In addition to giving the employer the opportunity to meet you, \nanother purpose of an interview is to give you a chance to evaluate the posi -\ntion. Applying for a volunteer position does not commit you to accepting it \nif it\u2019s offered. If you decide it isn\u2019t for you, you can always turn it down. If \nyou apply for several volunteer jobs, you will become more comfortable with \nthe entire interview process.\nU\u00caPractice interviews with family members or friends . Practicing job inter -\nviews with friends or family members is another good way to begin the \nprocess of overcoming anxiety over job interviews. You will need to coach \nyour friend or family member about the nature of the interview and the role \nthat he or she should take. You may also want to work up to having some \nof these role-play interviews become particularly challenging (for example, \nhave your helper play the role of a hostile interviewer), so you can learn to \nbe more comfortable with dif\ufb01cult interviews in real life.\nU\u00caApply for jobs that are not particularly interesting to you . A great way of \nlearning to overcome a fear of job interviews is to practice interviewing for \njobs that are not high on your list. You might as well learn how to interview \nmore effectively in situations in which you have little to lose. By practicing \ninterviewing for jobs you don\u2019t particularly want, you will be better pre -\npared when it comes time to interview for a job that interests you.", "source": "shyness_social.pdf"}
{"id": "ab78ffbdfe46-1", "page_content": "pared when it comes time to interview for a job that interests you.\nU\u00caApply for jobs that interest you . If you are looking for a new job, eventu -\nally you must be able to interview for the job you want. The more jobs you \napply for, the more interviews you will be offered. The more interviews that \nyou get, the more opportunities you will have to practice your interviewing \nskills and to overcome your fear of being interviewed. Although it\u2019s reason -\nable to start the process by interviewing for jobs that are not particularly \ninteresting to you, you should also be applying for jobs that you might really \nbe interested in accepting.\nCan you think of other possible practices that involve interviewing for a job? If so, \nrecord them in the space below:\nOther Practices", "source": "shyness_social.pdf"}
{"id": "4f3cc3ddd12d-0", "page_content": "The Shyness & Social Anxiety Workbook\n178Practices Involving Being in Public\nFor some people, just being around other people is anxiety provoking, even if there \nis no interaction or direct social contact. If being in a public place is dif\ufb01cult for you, \nhere are some examples of public places where you may be able to practice exposure. \nRemember to practice frequently and to stay long enough for your fear to decrease. If \nyou must leave the situation, try to return to it as soon as possible.\nU\u00caGo to a mall or supermarket . Shopping is a good way of exposing yourself \nto other people in a public place. Try shopping when the stores are more \ncrowded to challenge your fearful thoughts even more.\nU\u00caMake eye contact in a public place . If appropriate, make eye contact with \nother people while you walk down the street or while sitting on a bus or \nsubway. Of course, for safety reasons, this may not be wise in some cities, \nparticularly at night, or in dangerous parts of town.\nU\u00caGo to a concert or sporting event . A guaranteed place to encounter lots \nof other people is at a large concert, sporting event, movie theater, or other \nentertainment venue. If you prefer to sit in an aisle seat or near the exit (for \na quick escape), try sitting in the middle of the row and away from the exit.\nU\u00caRead in a public place . Spend some time reading your favorite book, a \nnewspaper, or a new novel at a coffee shop or library.\nU\u00caJoin a gym or take an aerobics class . Rather than exercising alone, practice \nexercising in front of others. For example, join an aerobics class and take a", "source": "shyness_social.pdf"}
{"id": "4f3cc3ddd12d-1", "page_content": "spot near the front of the room. Or, lift weights near other people who are \nmore experienced and stronger than you are.\nCan you think of other possible practices that involve being in public? If so, record \nthem in the space below:\nOther Practices\nPractices Involving Speaking to Authority Figures\nGoing out of your way to make contact with people in authority who make you feel \nuncomfortable is an effective way to learn how to be more comfortable with authority", "source": "shyness_social.pdf"}
{"id": "c5d48c45bec0-0", "page_content": "Exposure to Social Situations\n179\ufb01gures. Examples of relevant exposure practices are listed below. If any of these are \nsituations in which you would like to feel more comfortable, they may be appropriate \npractices for you to try.\nU\u00caHave a meeting with your boss or teacher . If you are a student, ask your \nteacher to meet with you to discuss a dif\ufb01cult homework assignment. If you \nare working, ask your boss for an appointment to discuss your performance \nor some other aspect of your job.\nU\u00caAsk a pharmacist questions about a medication . If you are taking any medi -\ncations, ask a pharmacist to answer particular questions about the medica -\ntion (for example, side effects, interactions with other medications, how to \nget re\ufb01lls, and so on). If you\u2019re not taking any medications, you can still ask \nquestions, perhaps on behalf of a friend or family member.\nU\u00caAsk your doctor to explain a particular medical issue . Make an appoint -\nment with your family doctor to ask questions about symptoms that you \nmay be experiencing. Be sure to have your questions answered.\nU\u00caMeet with your bank manager . For example, arrange to meet with your \nbank\u2019s manager or loan of\ufb01cer to discuss the possibility of obtaining a loan \nor mortgage.\nU\u00caMeet with a lawyer . For example, meet with a lawyer to discuss estate plan -\nning (writing a will) or some other legal issue that you are dealing with.\nU\u00caMeet with an accountant or \ufb01nancial advisor . Hire an accountant with \nwhom you feel intimidated to do your taxes, or meet with an intimidating \n\ufb01nancial advisor to get investment advice.\nCan you think of other possible practices that involve interacting with people in", "source": "shyness_social.pdf"}
{"id": "c5d48c45bec0-1", "page_content": "Can you think of other possible practices that involve interacting with people in \nauthority? If so, record them in the space below:\nOther Practices\nCHALLENGING YOUR WORST FEARS\nBy repeatedly exposing yourself to anxiety-provoking situations, you will continue to \nchallenge most of your deeply held beliefs and predictions concerning your ability", "source": "shyness_social.pdf"}
{"id": "c93cd35114d5-0", "page_content": "The Shyness & Social Anxiety Workbook\n180to cope with social and performance situations. Ideally, exposure practices should be \ndesigned to test the validity of your anxious assumptions. For example, if you are fearful \nof saying something foolish during a conversation at a party, it\u2019s not enough simply to \nattend parties, although just attending may be a reasonable \ufb01rst step. To more thor -\noughly challenge such an anxiety-provoking belief, you also would need to talk to other \npeople at the party. By having numerous conversations with others, eventually you will \nlearn that most of what you say is not foolish at all.\nAfter reaching a certain level of comfort talking to other people at parties, the next \nstep might be to practice saying something silly or foolish purposefully and to evalu -\nate the consequences. This exercise would help to challenge your anxious beliefs at an \neven deeper level. Chances are that even if you did say something foolish at a party, the \nconsequences would be minimal. With this type of exposure practice, you would learn \nnot only that you can engage in effective conversations with others, but that even if you \nmake a mistake from time to time, it doesn\u2019t really matter.\nThe strategies discussed in this section are useful for increasing the intensity of your \nexposure practices by testing out the validity of your \u201cWhat if?\u201d thoughts. Rather than \ndwelling on questions like \u201cWhat if I make a mistake?\u201d or \u201cWhat if I draw attention to \nmyself?\u201d we suggest that you try to answer these questions by purposefully making a \nmistake or purposefully drawing attention to your behavior. In all likelihood, you will \ndiscover that nothing terrible happens.\nPurposefully Making Mistakes or Trying to Look Stupid\nWhen you have begun feeling more comfortable in some of your feared situations,", "source": "shyness_social.pdf"}
{"id": "c93cd35114d5-1", "page_content": "When you have begun feeling more comfortable in some of your feared situations, \na reasonable next step is to make some small mistakes purposefully, or to do things that \nmake you look foolish or stupid. Examples of this kind of purposeful behavior include \npronouncing a word incorrectly while speaking to your boss, asking an obvious question \nin class, or bumping into a door. There is no need to make big mistakes (for example, \npurposefully failing an exam or crashing your car). Small mistakes will work just \ufb01ne, and \nthe consequences will be minimal.\nPurposefully Drawing Attention to Yourself\nIf being the center of attention is dif\ufb01cult for you, your exposure practices should \ninclude attempts to draw the attention of others to your behavior. For example, rather \nthan arriving early or on time for a movie or a class, try arriving a few minutes late, \nso that everyone is aware of you when you enter the room. You may feel  embarrassed \nmomentarily, but you will learn from the practice that the whole experience doesn\u2019t \nmatter, even minutes later. Your embarrassment will be temporary. Also, people prob -\nably will forget about your late arrival almost instantly and soon will be thinking about \nother things.", "source": "shyness_social.pdf"}
{"id": "b52b3dc88177-0", "page_content": "Exposure to Social Situations\n181Purposefully Increasing Your Anxiety Symptoms\nIn addition to entering the situations you fear, a more complete test of your anxiety-\nprovoking beliefs is to deliberately arouse some of the symptoms that frighten you in \nsocial or performance situations. Chapter 9 discusses these strategies in some detail. \nSome examples of possible exposure exercises include the following: wetting your fore -\nhead (to simulate sweating) before giving a presentation, purposefully appearing to lose \nyour train of thought during a meeting or presentation, and purposefully allowing your \nhands to shake while writing or holding a drink. By deliberately bringing on the symp -\ntoms you fear (in a predictable and controlled way), you will learn to be less frightened \nof having these symptoms show in front of others.\nExpressing Personal Opinions \nFinally, if you are afraid to express personal opinions during a conversation, just \nengaging in conversations, without expressing personal opinions, will not be enough to \ntest the validity of your fearful beliefs. Conversation alone will not teach you that your \nfears are unfounded. Instead, you should make sure that you express your feelings or \nopinions during your exposure practices.\nDEVELOPING A SITUATIONAL EXPOSURE \nHIERARCHY\nBefore beginning exposure therapy, it is helpful to generate a list of very speci\ufb01c situ -\nations that range in dif\ufb01culty from mildly to extremely anxiety-producing. This list of \nsituations, called a situational exposure hierarchy , will help to guide your exposure practices.\nUsually, the situations on the hierarchy include details that take into account particular \nthemes that contribute to how much fear you are likely to experience. These themes may \ninclude the size of the group or audience (for example, it may be easier to talk to one person", "source": "shyness_social.pdf"}
{"id": "b52b3dc88177-1", "page_content": "than \ufb01ve people; \ufb01ve people may be easier to handle than \ufb01fty), the length of time involved \n(for instance, a \ufb01ve-minute conversation vs. a thirty-minute conversation), your relationship \nwith the other person (for example, a family member vs. a stranger), and so on.\nTwo examples of situational exposure hierarchies follow. The \ufb01rst hierarchy is for a \nperson with the fear of public speaking, and the second is for someone who experiences \nsocial anxiety in many different situations (in other words, generalized social anxiety). \nNote that the hierarchy items are very speci\ufb01c with respect to the duration of the prac -\ntice, the types of people present, and other relevant variables. Developing speci\ufb01c items \nis important because it\u2019s dif\ufb01cult to develop practices based on overly vague hierar -\nchy items. Fear and avoidance ratings are based on a scale ranging from 0 (no fear, no \n avoidance) to 100 (maximum fear, complete avoidance).", "source": "shyness_social.pdf"}
{"id": "6e2f4a124323-0", "page_content": "The Shyness & Social Anxiety Workbook\n182Sample Situational Exposure Hierarchy: Public Speaking\nSituation Fear Avoidance\n1. Give a 1-hour, formal lecture to 200 strangers about a \ntopic that I don\u2019t know well.100 100\n2. Give a 1-hour, formal lecture to 30 strangers about a topic \nthat I don\u2019t know well.99 100\n3. Give a 1-hour, formal lecture to 200 strangers about a \nfamiliar topic.90 100\n4. Give a 1-hour, formal lecture to 30 strangers about a \nfamiliar topic.85 100\n5. Give a 1-hour, informal presentation to 20 coworkers \nabout an unfamiliar topic.85 90\n6. Give a 1-hour, informal presentation to 20 coworkers \nabout a familiar topic.70 70\n7. Give a 1-hour, informal presentation to 20 young children \nabout my work.65 65\n8. Make comments or ask questions in a large meeting (more \nthan 15 people).50 60\n9. Make comments or ask questions in a small meeting (5 or \n6 people).40 40\n10. Offer to make a toast at a family dinner. 35 35", "source": "shyness_social.pdf"}
{"id": "823dc8a091c2-0", "page_content": "Exposure to Social Situations\n183Sample Situational Exposure Hierarchy: Generalized Social Anxiety\nSituation Fear Avoidance\n1. Give a 1-hour, formal lecture to 30 coworkers about a \nfamiliar topic.100 100\n2. Have a party at my home for my coworkers. 95 95\n3. Ask Pat out for a dinner date. 90 100\n4. Answer a personal ad in the newspaper. 85 100\n5. Attend the annual holiday party at work without drinking \nalcohol.85 85\n6. Attend a tea for a coworker who is retiring. 70 70\n7. Have a formal dinner with Rita (a friend). 70 75\n8. Talk about personal feelings or opinions with my \ncoworkers.60 60\n9. Have a fast-food lunch with Rita. 60 50\n10.  Have a conversation with the person sitting next to me on \na bus.50 50\n11. Ask someone for directions or for the time. 45 45\n12. Call Rita on the telephone. 40 40\n13. Eat alone in a crowded food court at the mall. 40 40\n14. Walk around at a crowded mall. 35 35\n15. Answer the telephone without checking my caller ID. 30 30\nTo generate your own hierarchy, refer back to the suggested exposure practices in \nthis chapter as well as to the results of your self-assessment in chapter 3. Choose situations \nthat range in dif\ufb01culty from slightly anxiety-provoking to completely overwhelming.\nRecord these situations in order of dif\ufb01culty (starting with the most anxiety-pro -\nvoking at the top) in the spaces provided on the following blank Situational Exposure", "source": "shyness_social.pdf"}
{"id": "823dc8a091c2-1", "page_content": "voking at the top) in the spaces provided on the following blank Situational Exposure \nHierarchy Form. Next, rate each situation to describe the level of fear you would feel \nif you were in that situation right now (use any number from 0 to 100, where 0 = no \nfear; 25 = mild fear; 50 = moderate fear; 75 = intense fear; and 100 = very intense \nfear). Finally, using a 0- to 100-point scale, indicate how much you would tend to avoid \neach situation on your hierarchy (0 = do not avoid the situation; 25 = hesitate to enter \nsituation, but rarely avoid it; 50 = sometimes avoid the situation; 75 = usually avoid the \nsituation; 100 = always avoid the situation).", "source": "shyness_social.pdf"}
{"id": "d2c02a24f410-0", "page_content": "The Shyness & Social Anxiety Workbook\n184Situational Exposure Hierarchy Form\nSituation Fear \n(0\u2013100)Avoidance  \n(0\u2013100)\n1.                           \n                              \n2.                          \n                              \n3.                          \n                              \n4.                          \n                              \n5.                          \n                              \n6.                          \n                              \n7.                          \n                              \n8.                          \n                              \n9.                          \n                              \n10.                           \n                              \n11.                           \n                              \n12.                           \n                              \n13.                           \n                              \n14.                           \n                              \n15.", "source": "shyness_social.pdf"}
{"id": "516ee243ca38-0", "page_content": "Exposure to Social Situations\n185IMAGINED EXPOSURE TO SOCIAL SITUATIONS\nWhenever possible, in vivo exposure (actual exposure to feared situations) is preferable \nto exposure in the imagination. In fact, imagined exposure is rarely used for treating \nsocial anxiety. Still, exposure in the imagination may be useful either when the real situ -\nation is too overwhelming for you to enter or when you are unable to confront the actual \nsituation for practical reasons (for instance, you have an upcoming college exam and no \nearlier opportunities to practice taking it).\nImagined exposure may be helpful to prepare you to enter the actual situation. \nWhen you are using imagined exposure, the guidelines are generally the same as for in \nvivo exposure. For example, practices should be frequent (if possible, daily) and should \ncontinue until your fear decreases (for example, thirty to sixty minutes). Whenever pos -\nsible, imagined exposure should be followed by in vivo exposure in the actual situation.\nWhen conducting imagined exposure practices, close your eyes and try to imagine \nthe situation as vividly as possible. Some people \ufb01nd it helpful to make a tape recording \ndescribing the situation in detail and then listen to the tape during subsequent practices. \nOther people \ufb01nd it helpful simply to imagine being in the situation, without the help of \na recorded description. Either way, it\u2019s important to imagine the experience vividly, so \nthat it feels as real as possible. Your imagined exposure practices should produce many \nof the same feelings that are produced by real exposure, although the intensity of these \nfeelings may be lower during imagined exposure. We recommend that you ask yourself \nthe following questions to help bring the experience to life:\nU\u00caWhat do I see around me? What do my surroundings look like? Who else \nis here?", "source": "shyness_social.pdf"}
{"id": "516ee243ca38-1", "page_content": "is here?\nU\u00caWhat is happening in this situation?\nU\u00caWhat emotions am I feeling?\nU\u00caWhat thoughts am I thinking?\nU\u00caWhat physical sensations am I experiencing? How intense are they?\nU\u00caWhat is my environment like? Is it hot? Humid?\nU\u00caWhat am I doing while in this situation?\nU\u00caWhat sounds am I hearing?\nU\u00caWhat odors am I sensing?", "source": "shyness_social.pdf"}
{"id": "7a412d887eb3-0", "page_content": "The Shyness & Social Anxiety Workbook\n186SITUATIONAL ROLE-PLAY\nA situational role-play  is an exposure practice in which you rehearse being in a simulated \nsocial situation before actually entering the real situation. Role-play can provide you \nwith exposure practice without creating the same social risks that are sometimes present \nin the actual situation. In other words, you have less to lose during simulated exposures, \ncompared with real-life exposures. Below are some examples of how to use situational \nrole-plays to improve your level of comfort, as well as to improve your skills for dealing \nwith particular social situations:\nU\u00caBefore giving a formal presentation at work, practice giving your talk to \nseveral friends and relatives. Ask your simulated audience for feedback. If \npossible, repeat this role-play practice several times.\nU\u00caIf you\u2019re nervous about making small talk with strangers at parties, ask \nyour partner (or any close friend or relative) to pretend to be an unfamiliar \nperson. Imagine that you have both arrived early for a party and are waiting \nin the living room while the host prepares food in the kitchen. Practice \nengaging in small talk, as if you have just met for the \ufb01rst time.\nU\u00caIf you have an upcoming job interview, you can prepare by having friends \nor relatives simulate interviewing you for a job.\nU\u00caIn order to practice asking another individual out on a date, you could \nrehearse what you might say with a close friend or relative.", "source": "shyness_social.pdf"}
{"id": "1f5f40304996-0", "page_content": "Exposure to Social Situations\n187In the spaces below, record several more simulated exposure role-plays you could \nuse to begin confronting the situations that you fear:\n1.  \n2.  \n3.  \n4.  \n5.", "source": "shyness_social.pdf"}
{"id": "8184d03894fb-0", "page_content": "The Shyness & Social Anxiety Workbook\n188USING EXPOSURE RECORDS AND DIARIES\nKeeping good records during exposure practices will help you to monitor your progress \nover time. The Exposure Monitoring Form at the end of this chapter is an example of a \ndiary that can be used to record your experiences during exposure practices. In addition, \nthis form is designed to help you challenge your anxious thoughts during exposure prac -\ntices. Note that although the Exposure Monitoring Form may seem somewhat complex \nat \ufb01rst, with practice it will become easier to complete.\nAt the top of the form, you should describe the particular situation that you\u2019re \npracticing; the date, time, and duration of the practice; and your fear level before and \nafter the practice (use a 0- to 100-point scale, where 0 = no fear and 100 = maximum \nfear). The middle part of the form is used for testing the validity of your fearful beliefs \nand predictions regarding the exposure practice. The \ufb01rst three columns are completed \nbefore the practice, and the last column is completed after the practice.\nIn the \ufb01rst column, record your emotional response to the upcoming practice \n(responses like fear or nervousness). The second and third columns are used for record -\ning your fearful beliefs and predictions, as well as the evidence regarding the validity \nof these predictions. (Chapter 6 has many examples of possible fearful beliefs as well \nas instructions on how to evaluate the evidence concerning these thoughts.) After the \npractice is completed, record the outcome of the practice (what actually happened), any \nnew evidence generated by the practice, and what you learned about the accuracy of \nyour original anxiety-provoking thoughts and predictions.\nIn the lower part of the form, there is space to record your fear level periodically", "source": "shyness_social.pdf"}
{"id": "8184d03894fb-1", "page_content": "In the lower part of the form, there is space to record your fear level periodically \nduring the practice, using a scale ranging from 0 (no fear) to 100 (maximum fear). The \nfrequency with which you record your fear ratings will depend on the duration of the \npractice. For example, ratings might be recorded every minute for a practice lasting ten \nminutes, or every thirty minutes for a practice lasting all day. There is space to provide \nup to twenty fear ratings during the practice, though you will probably not need that \nmany. The last step is to plan for your next practice by answering the question, \u201cBased \non this experience, what exposure will I do next?\u201d\nA STEP-BY-STEP GUIDE TO CONDUCTING \nEXPOSURE TO SOCIAL SITUATIONS\nA comprehensive exposure-based treatment should include the following steps:\nU\u00caDevelop a situational exposure hierarchy.  Although the hierarchy should \nbe used to guide your exposure practices, you can be \ufb02exible. For example, \nfeel free to work on situations that are not on your hierarchy. In addition, \nyou may decide to revise your hierarchy as particular situations become less \nanxiety-provoking.", "source": "shyness_social.pdf"}
{"id": "5a3012179fdc-0", "page_content": "Exposure to Social Situations\n189U\u00caPlan your exposure practices on a week-by-week basis. At the start of each \nweek, you should have a good idea of the types of practices that you will \nconduct over the coming week, as well as the dates and times you\u2019ll conduct \nthese practices.\nU\u00caDevelop a long-term exposure plan.  You should have an idea of the types \nof situations in which you are likely to conduct exposure practices over \nthe coming months. Of course, this plan probably will change frequently, \ndepending on the results of your practices each week.\nU\u00caStart with exposure to situations that are near the bottom or middle of \nyour hierarchy.  If a situation is too dif\ufb01cult, try something easier. If a prac -\ntice doesn\u2019t create anxiety, try something more dif\ufb01cult.\nU\u00caGradually increase the dif\ufb01culty level of practices.  As exposures to par -\nticular situations become easier, begin practicing exposure in situations that \nare more anxiety-provoking.\nINTEGRATING SITUATIONAL EXPOSURE \nSTRATEGIES INTO YOUR TREATMENT PLAN\nAlthough exposure to feared situations is perhaps the most important technique for \novercoming your fear, the exposure methods described in this chapter (and in chapter 7) \nare often most effective when they are used as part of a comprehensive treatment plan. \nIn addition to situational exposure, your treatment should include the cognitive strate -\ngies described in chapter 6, which will help you to reinterpret your experiences during \nexposure to feared situations. As we reviewed earlier in this book, we recommend that \nyou \ufb01rst practice the cognitive techniques for several weeks before formally beginning \nexposure practices.\nAlso, your treatment program may include medication (chapter 5), exposure to", "source": "shyness_social.pdf"}
{"id": "5a3012179fdc-1", "page_content": "Also, your treatment program may include medication (chapter 5), exposure to \nfeared sensations (chapter 9), and social-skills practices (chapter 10), depending on your \nown personal needs and preferences. As you will see, these strategies are typically used \nin the context of your own situational exposure practices. Exposure is the foundation \naround which the other treatment strategies are introduced.", "source": "shyness_social.pdf"}
{"id": "139f31713881-0", "page_content": "The Shyness & Social Anxiety Workbook\n190\nExposure Monitoring Form\nExposure Situation            Date and Time        \nInitial Fear Level (0-100)           Fear Level at End (0\u2013100)             Duration of Exposure            \nCOMPLETE BEFORE THE EXPOSURE PRACTICE COMPLETE AFTER THE EXPOSURE PRACTICE\nWhat emotions (e.g., \nfear, anger) do you \nhave as you think \nabout doing this \nexposure?What anxiety-provoking thoughts, \npredictions, and assumptions do \nyou have about the exposure? \nWhat do you expect will happen \nduring the exposure practice?What  \nevidence do \nyou have that \nyour fearful \nthoughts are \ntrue?1. What was the outcome  of this practice? What \nactually happened?\n2. What evidence  did you gain from this practice? \nHow accurate were your original thoughts and \npredictions?\n1. Outcome of Practice\n2. Evidence Gained\nFear Ratings (0\u2013100)\nProvide occasional fear ratings (0\u2013100) over the course of the exposure practice. For example, for a 20-minute exposure practice, record \nratings every 5 minutes or so. For a 2-hour exposure practice, record ratings every 15 minutes or so. Space is provided for a total of 20 \nratings over the course of the practice.\n1.    2.    3.    4.    5.    6.    7.    8.    9.    10.    \n11.    12.    13.    14.    15.    16.    17.    18.    19.    20.    \nBased on this experience, what exposure practice will you complete next?", "source": "shyness_social.pdf"}
{"id": "139f31713881-1", "page_content": "Based on this experience, what exposure practice will you complete next?  \n\u00a9 2000 Peter J. Bieling, Ph.D., and Martin M. Antony, Ph.D. Reprinted with permission.", "source": "shyness_social.pdf"}
{"id": "169dc0156a0b-0", "page_content": "CHAPTER 9\nExposure to  \nUncomfortable Sensations\nSymptom exposure (also called interoceptive exposure ), involves intentional exposure to inter -\nnal physical sensations, such as dizziness, racing heart, sweating, shaking, and blushing. \nThis technique was originally developed as a treatment for an anxiety-based condition \nknown as panic disorder . Panic disorder is a problem in which people experience sudden \nrushes of fear without any obvious trigger or cause. People with panic disorder tend to \nbe very fearful of the physical sensations they experience during their panic attacks, \nand they often interpret these symptoms as a sign of imminent danger or threat (like an \nimpending heart attack or a complete loss of control). Symptom exposure was developed \nto teach those with panic disorder to stop fearing the physical feelings associated with \nphysical arousal and anxiety. With repeated exposure to these induced physical symp -\ntoms, people learn that these feelings are not dangerous, and they eventually become \nless frightened of their own internal feelings and sensations.\nAnxiety over experiencing physical arousal symptoms is not unique to panic dis -\norder. A number of studies (Chambless and Gracely 1989; Taylor, Koch, and McNally \n1992) have found that people with other anxiety-based problems are also often anxious \nabout experiencing certain physical sensations. This includes people with social anxiety, \nwhere the fear may be strongest for sensations that might be visible to others, including \nblushing, sweating, shaking, and losing one\u2019s train of thought. Just as symptom exposure \nleads to reduced fear of sensations in people with panic disorder, it makes sense that \ndeliberately exposing oneself to feared symptoms while in social situations might lead to \ndecreased fear of sensations for people with high levels of social anxiety. By combining", "source": "shyness_social.pdf"}
{"id": "b8519f956a6f-0", "page_content": "The Shyness & Social Anxiety Workbook\n192symptom exposure and situational exposure, you will learn that you can not only toler -\nate being in feared situations with your usual levels of physical arousal, but that you can \ntolerate the situation even when your feared physical sensations are particularly intense. \nBy bringing on these sensations in a controlled and predicable way, you will learn to be \nless anxious about experiencing them in social situations.\nAlthough there hasn\u2019t been much research on the use of symptom exposure in social \nanxiety, we have found that this technique is often helpful for those who suffer from \nexcessive social and performance fears (Antony and Swinson 2000; Antony and Rowa \n2008). The techniques described in this chapter are not meant to be used instead of \nthe strategies described in earlier chapters. In fact, to overcome your social anxiety, the \nmost important strategies are the cognitive techniques described in chapter 6 and the \nsituational exposure strategies described in chapters 7 and 8. You should not attempt to \nuse symptom exposure until you have practiced the strategies described in chapters 6 \nthrough 8 and are thoroughly familiar with them.\nFurthermore, before attempting the symptom exposure techniques, you should \nbe very familiar with the basic rules of exposure. As reviewed in chapter 7, exposure \nworks best if it is practiced frequently, if each practice lasts long enough to show that \nyour feared consequences don\u2019t come true, and if practices are predictable and under \nyour control. In addition, the cognitive strategies described in chapter 6 should be used \nto combat anxious thinking before, during, and after your exposure practices. Finally, \nduring your exposure practices, you should not use subtle avoidance techniques such as \ndistraction, drug or alcohol use, or other safety behaviors (for example, wearing makeup", "source": "shyness_social.pdf"}
{"id": "b8519f956a6f-1", "page_content": "distraction, drug or alcohol use, or other safety behaviors (for example, wearing makeup \nto hide blushing).\nINTRODUCTION TO SYMPTOM EXPOSURE\nSymptom exposure involves using speci\ufb01c exercises to bring on physical sensations that \nmake you uncomfortable or anxious. Initially, the exercises are practiced in \u201csafe\u201d situa -\ntions, like your home. After you get used to the exercises, the next step is to try them \nin anxiety-provoking situations, such as immediately before entering a social or perfor -\nmance situation. Examples of symptom exposure exercises are listed here, along with \nthe sensations they typically trigger (Antony et al. 2006; Antony and Swinson 2000). \nIn addition to this list, there are many other possible exercises that can be used. For \nexample, if you are afraid of a choking or gagging feeling in your throat, wearing a \nnecktie or scarf may be a good way of creating this feeling for the purpose of exposure \ntherapy. It\u2019s best to consider these exercises only as a partial list. At the end of the list, \nthere is space for you to record additional exercises that might be useful for triggering \nsymptoms that you fear.", "source": "shyness_social.pdf"}
{"id": "2c1724f6b4ec-0", "page_content": "Exposure to Uncomfortable Sensations\n193Examples of Symptom Exposure Exercises and Typical Sensations Experienced\nSymptom Exposure Exercise Typical Sensations\nShake head from side to side (30 sec.) Dizziness, faintness, lightheadedness\nSpin around in a swivel chair (60 sec.) Dizziness, faintness, lightheadedness\nHyperventilate (shallow breathing at a \nrate of about 100\u2013120 breaths per min.; \n60 sec.)Breathlessness or smothering feelings, \ndizziness or lightheadedness, racing  \nor pounding heart, feeling unreal,  \ntrembling or shaking, numbness or  \ntingling sensations\nBreathe through a small, narrow straw \n(plug your nose if necessary; 2 min.)Breathlessness or smothering feelings, \nracing or pounding heart, choking  \nfeelings, dizziness or lightheadedness, \nchest tightness, trembling or shaking\nTense all the muscles in the body (60 \nsec. or as long as possible)Trembling or shaking, breathlessness  \nor smothering feelings, racing or  \npounding heart, dizziness or  \nlightheadedness, blushing\nCarry heavy weights or bags (60 sec. or \nas long as possible)Trembling or shaking, breathlessness or \nsmothering feelings, racing or pounding \nheart, dizziness or lightheadedness,  \nhot \ufb02ushes\nRun on the spot or run up and down \nstairs (60 sec.)Racing or pounding heart, breathlessness \nor smothering feelings, chest tightness, \nsweating, trembling or shaking, blushing\nSit in a hot, stuffy space (for example,", "source": "shyness_social.pdf"}
{"id": "2c1724f6b4ec-1", "page_content": "Sit in a hot, stuffy space (for example, \na sauna, hot car, or small room with \na space heater; 5 to 10 min.) or wear \noverly warm clothingSweating, breathlessness or smothering \nfeelings, hot \ufb02ushes, blushing\nHave a hot drink or hot soup Sweating, blushing, hot \ufb02ushes\nOther Exercises to Trigger Sensations I Fear\nExercise           Symptoms", "source": "shyness_social.pdf"}
{"id": "caaa82bafd9b-0", "page_content": "The Shyness & Social Anxiety Workbook\n194IS SYMPTOM EXPOSURE FOR YOU?\nAlthough symptom exposure is likely to be helpful for many who suffer from social \nanxiety, it\u2019s usually possible to reduce social anxiety without this particular strategy. In \nfact, for some people, there may be little reason to use these exercises at all. Symptom \nexposure is likely to be helpful to you if either of the following statements is true:\nU\u00caYou are generally afraid of experiencing anxiety symptoms such as a rapidly \nbeating heart, dizziness, shaking, blushing, or sweating.\nU\u00caYou are afraid of experiencing anxiety symptoms in front of other people.\nIf you\u2019re fearful of experiencing physical arousal feelings in general or when in social \nor performance situations, we recommend trying the exercises described in this chapter. \nHowever, if you are not fearful of the sensations that you experience when anxious, and \nyou are not concerned about others noticing your anxiety symptoms, then there is no \nneed to practice these exercises. In fact, you can skip ahead to chapter 10.\nHOW DOES SYMPTOM EXPOSURE WORK?\nLike situational exposure, symptom exposure is believed to decrease fear by disprov -\ning a person\u2019s fearful beliefs, assumptions, and predictions. By deliberately bringing on \nuncomfortable feelings in a controlled and predictable way, you will learn that (1) you \ncan control the sensations that normally appear to be uncontrollable and (2) even if you \ndo experience noticeable physical feelings in front of other people, the consequences \nare likely to be minimal.\nBy learning to allow yourself to be anxious in front of other people, and to allow \nothers to observe your anxiety symptoms, eventually you will become less concerned \nabout your anxiety reactions and about what people think when they notice your shaking,", "source": "shyness_social.pdf"}
{"id": "caaa82bafd9b-1", "page_content": "about your anxiety reactions and about what people think when they notice your shaking, \nsweating, blushing, or other signs of anxiety. By becoming less concerned about experi -\nencing these feelings, you will probably become less anxious when exposed to social and \nperformance situations.", "source": "shyness_social.pdf"}
{"id": "2bdc51fa76a1-0", "page_content": "Exposure to Uncomfortable Sensations\n195A WARNING ABOUT SYMPTOM EXPOSURE\nIf you are healthy, the exercises described in this chapter are safe. However, if you have \ncertain health problems, some of the exercises could worsen your condition. For example, \nif you have asthma or a bad cold, you should probably not practice hyperventilation or \nbreathing through a straw. If you experience neck or back pain, we recommend against \nshaking your head from side to side or engaging in any exercises that could aggravate \nyour condition. To be safe, we recommend checking with your doctor to see if any of \nthese exercises are likely to be dangerous or problematic for you.\nA STEP-BY-STEP GUIDE TO SYMPTOM EXPOSURE\nThis section describes the four main steps involved in using symptom exposure to over -\ncome the fear of experiencing physical arousal sensations. These include (1) discovering \nwhich exercises are most effective for bringing on feared symptoms, (2) developing a \nsymptom exposure hierarchy, (3) practicing the exercises in nonsocial situations, and (4) \ncombining the symptom exposure exercises with exposure practices in social situations.\nStep 1: Symptom Induction Testing\nBefore beginning to practice symptom exposure exercises on a regular basis, you \nshould \ufb01rst determine which exercises are most likely to be effective for you. This can \nbe achieved by attempting each exercise at home and paying attention to the types of \nsymptoms that you experience, the effect of the exercises on your fear level, and how \nsimilar the experience is to the fear that you normally experience in social situations. \nThe following Symptom Induction Testing Form can be used to record your responses \nto each exercise. We have included space for additional exercises that you may have \nidenti\ufb01ed earlier in the chapter.", "source": "shyness_social.pdf"}
{"id": "9333716b8ac6-0", "page_content": "The Shyness & Social Anxiety Workbook\n196Symptom Induction Testing Form\nInstructions : After trying each symptom exposure exercise, (1) record the physical sen -\nsations that were experienced and (2) rate the intensity of fear experienced using a scale \nof 0 (no fear) to 100 (maximum fear).\nExercise Sensations Experienced Fear (0\u2013100)\nShake head from side to side  \n(30 sec.)  \nSpin around in a swivel chair  \n(60 sec.)  \nHyperventilate (shallow breathing at \na rate of about 100\u2013120 breaths per \nmin.; 60 sec.)\nBreathe through a small, narrow \nstraw (plug your nose if  \nnecessary; 2 min.)\nTense all the muscles in the body (60 \nsec. or as long as possible)  \nCarry heavy weights or bags  \n(60 sec. or as long as possible)  \nRun on the spot or run up and down \nstairs (60 sec.)  \nSit in a hot, stuffy space (for \nexample, a sauna, hot car, or small \nroom with a space heater; 5 to 10 \nmin.) or wear overly warm clothing\nHave a hot drink or hot soup  \n \nOther Exercise\nOther Exercise", "source": "shyness_social.pdf"}
{"id": "dcca6f451c84-0", "page_content": "Exposure to Uncomfortable Sensations\n197Step 2: Developing Symptom Exposure Hierarchies\nJust as the situational exposure hierarchy described in chapter 8 is used to guide your \nsituational exposure practices, symptom exposure hierarchies  are useful for choosing appropri -\nate symptom exposure exercises. In most cases, we recommend that you develop two \nsymptom exposure hierarchies: one for practicing the exercises outside of social situa -\ntions (see step 3) and a second hierarchy for practicing symptom exposure while in (or \nimmediately before entering) social or performance situations (see step 4). If you are \nnot at all fearful of experiencing anxiety sensations outside of social situations, then \ndeveloping a hierarchy for practicing symptom exposure in nonsocial situations is less \nimportant. Instead, you should focus on exercises to practice while exposed to social and \nperformance situations.\nTo develop a hierarchy for symptom exposure, \ufb01rst eliminate any exercises that \nyou know will not make you anxious (based on the results of your symptom induction \ntesting, completed in step 1). For example, if the sensations created by physical exercise \n(something like jogging) are not frightening to you at all, eliminate this exercise from \nyour list. Next, take the remaining exercises and put them in order of dif\ufb01culty, with the \nleast anxiety-provoking exercise at the bottom and the most anxiety-provoking item at \nthe top. Record your level of expected fear for each exercise, using a scale ranging from \n0 (no fear) to 100 (maximum fear). Examples of symptom exposure hierarchies re\ufb02ecting \npractices outside of social situations and practices in social situations follow. We have \nalso included space to record your own hierarchies.", "source": "shyness_social.pdf"}
{"id": "dcca6f451c84-1", "page_content": "also included space to record your own hierarchies. \nSample Symptom Exposure Hierarchy for Practices in Nonsocial Situations\nExercise Fear Rating  \n(0\u2013100)\n1. Hyperventilate at home alone (1 minute). 60\n2. Breathe through a straw at home alone (2 minutes). 45\n3. Spin in a chair at home alone (1 minute). 35\n4. Shake head from side to side at home alone (30 seconds). 30", "source": "shyness_social.pdf"}
{"id": "e3eda3afea7f-0", "page_content": "The Shyness & Social Anxiety Workbook\n198My Symptom Exposure Hierarchy for Practices in Nonsocial Situations\nExercise Fear Rating  \n(0\u2013100)\n1.                              \n                               \n2.                              \n                               \n3.                              \n                               \n4.                              \n                               \n5.                              \n                               \n6.                              \n                               \n7.                              \n                               \n8.                              \n                               \n9.                              \n                               \n10.                               \n                               \nSample Symptom Exposure Hierarchy for Practices in Social Situations\nExercise Fear Rating  \n(0\u2013100)\n1. Hold a heavy bag for 60 seconds immediately before holding a \ufb01lled \nglass in front of others (to induce shaky hands).100\n2. Breathe through a straw for 2 minutes immediately before entering a \ncocktail party and making small talk.80\n3. Wear a warm sweater while giving a presentation. 80\n4. Eat hot soup to induce \ufb02ushing and sweating at a dinner party. 60", "source": "shyness_social.pdf"}
{"id": "e22246cb41aa-0", "page_content": "Exposure to Uncomfortable Sensations\n1995. Run around the block before entering a party. 40\n6. Hyperventilate just before calling someone on the telephone. 35\nMy Symptom Exposure Hierarchy for Practices in Social Situations\nExercise Fear Rating  \n(0\u2013100)\n1.                              \n                               \n2.                              \n                               \n3.                              \n                               \n4.                              \n                               \n5.                              \n                               \n6.                              \n                               \n7.                              \n                               \n8.                              \n                               \n9.                              \n                               \n10.                               \n                               \nStep 3: Practicing Symptom Exposure in  \nNonsocial Situations\nIf you are not fearful of practicing the symptom exposure exercises in nonsocial \nsituations, it is not necessary to spend a lot of time on step 3. However, if there are \nexercises that you intend to practice in social situations (step 4), we recommend that", "source": "shyness_social.pdf"}
{"id": "430b3cfc928f-0", "page_content": "The Shyness & Social Anxiety Workbook\n200you \ufb01rst try them a few times in nonsocial situations to make sure that you are familiar \nwith the exercise.\nIf there are exercises that are anxiety-provoking for you in nonsocial situations, we \nrecommend that you practice them repeatedly at home or in another comfortable loca -\ntion place before practicing in social situations. Use your symptom exposure hierarchy \nfor nonsocial situations to help you choose which exercises to practice. Begin with exer -\ncises that are challenging but unlikely to be so overwhelming that you cannot complete \nthem. After you have chosen an exercise, set aside about \ufb01fteen minutes twice a day \nto practice the exercise repeatedly. After each repetition of the exercise, take a short \nbreak (from thirty seconds to a few minutes) until the symptoms decrease. Continue to \npractice the exercise another \ufb01ve or six times or until your fear has decreased. Later in \nthis chapter, you will \ufb01nd a diary you can use to record the results of each practice and \nto challenge any anxiety-provoking thoughts that arise during the practice.\nEach time you complete an exercise, you will experience the physical symptoms \nassociated with it. However, your fear of the symptoms should decrease across individual \npractices and across days. For example, if you are practicing hyperventilation, you will \nlikely continue to become hot and lightheaded each time you do the exercise. However, \nover time, these feelings should become less frightening.\nStep 4: Practicing Symptom Exposure in Social Situations\nAfter you have practiced situational exposure (chapter 8) and symptom exposure \nin nonsocial situations, the next step is to combine these two approaches. Combining \nsymptom and situational exposure is one of the most challenging types of exposure", "source": "shyness_social.pdf"}
{"id": "430b3cfc928f-1", "page_content": "symptom and situational exposure is one of the most challenging types of exposure \nthat you can practice. However, this type of exposure can also provide you with the \nstrongest possible evidence that your anxious predictions are exaggerated or untrue. By \nentering the social and performance situations that you fear and purposefully inducing \narousal sensations to enhance your fear, you will learn that these situations are man -\nageable even when you feel extremely uncomfortable. To select possible exercises for \ncombining symptom and situational exposure, refer back to your symptom exposure \nhierarchy for practices in social situations (step 2).\nINTEGRATING SYMPTOM EXPOSURE INTO \nYOUR TREATMENT PLAN\nAs discussed earlier, we recommend that your psychological treatment program (cogni -\ntive behavioral therapy) begin with the cognitive strategies discussed in chapter 6. After \npracticing the cognitive techniques for several weeks, you should practice situational \nexposure for several more weeks or months until you feel more comfortable in social \nsituations (chapters 7 and 8). Only then should you consider adding symptom exposure", "source": "shyness_social.pdf"}
{"id": "0406555d0c5e-0", "page_content": "Exposure to Uncomfortable Sensations\n201if you are still fearful of experiencing anxiety symptoms in front of others. As your fear \ncontinues to decrease through exposure and cognitive therapy, you may also consider \nworking on your social and communication skills (chapter 10).\nUSING SYMPTOM EXPOSURE RECORDS  \nAND DIARIES\nKeeping good records during symptom exposure practices will help you to monitor your \nprogress over time. The Symptom Exposure Diary at the end of this chapter will help \nyou to measure changes in your fear across symptom exposure practices. Furthermore, \nthis diary is designed to help you challenge your anxious thoughts during exposure \npractices. The \ufb01rst column indicates the trial number (1, 2, 3, and so on). In the second \ncolumn, you should record the speci\ufb01c sensations that you experience. In the third \ncolumn, record your fear level during each exercise trial. Finally, the fourth and \ufb01fth \ncolumns are for recording your anxious thoughts during the exercise and for countering \nyour thoughts with more realistic beliefs.\nTROUBLESHOOTING\nProblem:  The symptom exposure exercises don\u2019t frighten me.\nSolution:   If the exercises don\u2019t cause anxiety when you practice them in nonsocial \nsituations, try practicing them immediately before entering social situa -\ntions. If they still don\u2019t increase your fear, then discontinue the symptom \nexposure exercises. However, you should continue to use the cognitive \nstrategies (chapter 6) and the situational exposure exercises (chapters 7 \nand 8).\nProblem:   The symptom exposure exercises are too overwhelming for me to complete.\nSolution:   If a symptom exposure exercise is too overwhelming, even when conducted \nin a nonsocial situation, try an easier exercise from your hierarchy and", "source": "shyness_social.pdf"}
{"id": "0406555d0c5e-1", "page_content": "in a nonsocial situation, try an easier exercise from your hierarchy and \ndon\u2019t move on to the more dif\ufb01cult exercises until the easier ones become \nmanageable. If you \ufb01nd that a symptom exposure exercise is overwhelming \nonly when practiced in the context of a social or performance situation, \nyou can practice an easier exercise from your symptom exposure hierarchy \nand work your way up to the more dif\ufb01cult exercises. Or, you can continue \nto practice situational exposure without the symptom exposure exercises. \nHold off on introducing symptom exposure practices in social situations \nuntil you are able to manage the situation on its own (without symptom \nexposure).", "source": "shyness_social.pdf"}
{"id": "d10c703473d9-0", "page_content": "The Shyness & Social Anxiety Workbook\n202\nSymptom Exposure Diary\nInstructions : This form should be completed each time you practice symptom exposure. For each symptom exposure trial: (1) list the \nphysical symptoms that you experienced; (2) rate the intensity of your fear using a scale of 0 (no fear) to 100 (maximum fear); (3) list your \nspeci\ufb01c anxious predictions regarding the exercise (What might happen during the exercise?); and (4) list alternative nonanxious predictions \nand evidence supporting these nonanxious predictions (countering).\nExposure Exercise             \nDate and Time          \nTrial \n#Sensations Experienced Fear Anxiety-Provoking Thoughts \nand PredictionsCountering\n1\n2\n3\n4\n5\n6\n7\nAdapted from Antony, M.M., and R. P.  Swinson. 2000. Phobic Disorders and Panic in Adults: A Guide to Assessment and Treatment . Washington, DC: American Psychological \nAssociation. Used with permission.", "source": "shyness_social.pdf"}
{"id": "85bfa1231ce5-0", "page_content": "CHAPTER 10\nCommunicating  \nMore Effectively\nAre there times when your behavior communicates to others a message that\u2019s different \nfrom what you are trying to communicate? Do you freeze up in interviews? Do you tend \nto avoid eye contact when talking to other people? Does your body language tell others \nto stay away ? Do you read your presentations verbatim so you don\u2019t make any mistakes? \nDo others often feel as though you aren\u2019t listening to them? Do people misinterpret \nyour shyness as a sign of aloofness or a snobby attitude? This chapter is all about how \nto communicate effectively and to get your message across in the way you intend.\nGETTING YOUR MESSAGE ACROSS\nFor some people, a consequence of avoiding social situations is never having the oppor -\ntunity to master the communication skills that would help them deal effectively with \nothers. For example, if your fear has stopped you from applying for jobs or asking people \nout on dates, you may not always know how to best deal with these situations (what to \nsay, what to wear, how to behave, and so on). The ability to interact effectively with \nother people must be learned and it takes practice, just like learning to play the piano or \ntraining to run a marathon. As you get more experience being in the situations you avoid, \nand learning what works and what doesn\u2019t, your performance is likely to improve. This \nchapter provides ideas for enhancing the quality of your interactions with other people. \nMost of these strategies can be used during the course of your situational  exposure \npractices (chapters 7 and 8).", "source": "shyness_social.pdf"}
{"id": "b765e260a7ac-0", "page_content": "The Shyness & Social Anxiety Workbook\n204As you read this chapter, there are a few important points to keep in mind. First, our \npurpose in writing this chapter is not to suggest that you lack social skills. In fact, most \npeople we have worked with who have problems with social anxiety have \ufb01ne social skills \noverall. If anything, your social and communication skills are probably already much \nbetter than you think they are. Rather, our aim is to help you increase your awareness \nof the different ways in which your behavior may impact others and to change speci\ufb01c \nbehaviors where appropriate.\nYou should also bear in mind that there is no such thing as perfect social skills. What \nworks best in one situation or with one group of people may not work well in another \nsituation or with another group. For example, the best way to ask one person out on a \ndate may cause a rejection from someone else. Although a particular style may help you \nget one job, it may work against you for another job or with another interviewer. In other \nwords, no matter how well-developed your social skills are, they can never be perfect. \nLike everyone, you will continue to stumble from time to time and occasionally you will \nmake a bad impression on other people.\nFinally, the strategies described in this chapter should not be thought of as rules to \nbe followed by everyone. Rather, they are suggestions and guidelines that you may \ufb01nd \nhelpful in some situations. For example, we suggest that certain types of body language \n(for example, standing too far away from another person during a conversation) may \nbe interpreted as a sign of aloofness or that you are uninterested in talking. However, \nstanding too close also may cause other people to feel uncomfortable. Unfortunately,", "source": "shyness_social.pdf"}
{"id": "b765e260a7ac-1", "page_content": "standing too close also may cause other people to feel uncomfortable. Unfortunately, \nit\u2019s very dif\ufb01cult to determine the ideal amount of \u201cpersonal space.\u201d What works well \nwith one person may not work as well with another. Personal space preferences also vary \nacross ethnic groups and subcultures. That is, among some groups, standing quite close \nto the person with whom you\u2019re speaking is the norm. But in another group that norm \nmight cause great discomfort. Given that it is often dif\ufb01cult to know how to behave in \na particular situation, it\u2019s best not to get too caught up in whether you are using these \nstrategies perfectly or whether you\u2019re making a perfect impression on others.\nExamples of communication skills discussed in this chapter are provided here. \nAs you read through the list, pay attention to the speci\ufb01c skills you are interested in \nimproving.", "source": "shyness_social.pdf"}
{"id": "6169a1e4392e-0", "page_content": "Communicating More Effectively\n205Skill Examples\nListening skills U\u00caListening carefully to others when they are speaking, \ninstead of comparing yourself to the other person, ruminat -\ning about what you will say next, and so on\nNonverbal  \ncommunication \nskillsU\u00caMaking appropriate eye contact when talking to other people\nU\u00caAttending to body language\nU\u00caStanding at an appropriately close distance to other people \nduring conversations\nU\u00caSmiling appropriately\nU\u00caSpeaking with a con\ufb01dent tone and a volume level that \nothers can hear\nConversation \nskillsU\u00caStarting and stopping conversations\nU\u00caKeeping conversations \ufb02owing\nU\u00caNot putting yourself down in front of others\nU\u00caNot apologizing unnecessarily\nU\u00caDisclosing information about yourself when appropriate\nInterview skills U\u00caPreparing for interviews\nU\u00caDeciding what to wear\nU\u00caAnticipating the interviewer\u2019s questions\nU\u00caPreparing questions to ask\nU\u00caWhat to do after the interview is over\nAssertiveness \nskillsU\u00caCommunicating assertively rather than in a way that is either \ntoo passive or too aggressive; asking for what you want\nU\u00caDealing with con\ufb02ict, particularly with people with whom \nyou disagree or who might be angry or hostile toward you\nU\u00caLearning the difference between imposing on others\u2019 time \nand privacy vs. making a reasonable request for help or \nsocial contact\nSkills for meeting \nnew people and \ndatingU\u00caBasic manners\nU\u00caFinding people to date\nU\u00caAsking someone to lunch or dinner\nU\u00caGenerating conversation topics\nU\u00caEnding a date gracefully\nU\u00caDealing with rejection\nPublic speaking \nand presentation", "source": "shyness_social.pdf"}
{"id": "6169a1e4392e-1", "page_content": "U\u00caDealing with rejection\nPublic speaking \nand presentation \nskillsU\u00caEngaging the audience\nU\u00caDesigning slides and other audiovisual aids\nU\u00caOrganizing your talk\nU\u00caHandling questions from the audience", "source": "shyness_social.pdf"}
{"id": "77a23093cd68-0", "page_content": "The Shyness & Social Anxiety Workbook\n206Of course, it is impossible to thoroughly cover all of these topics in a single chapter. \nIndeed, numerous books have been written on each of these particular domains (pre -\nsentations, interviews, dating, assertiveness, listening, and so on). For more detailed \nsuggestions, consult some of the recommended readings cited throughout this chapter \nand in the list of additional recommended readings at the back of the book. In addi -\ntion, there are a number of good books that cover a wide range of topics related to \nsocial and  communication skills. Some examples include Messages: The Communication Skills \nBook (McKay, Davis, and Fanning 1995), The Messages Workbook: Powerful Strategies for Effective \nCommunication at Work & Home  (Davis, Paleg, and Fanning 2004), and Robert Bolton\u2019s classic \nbook, People Skills (1979).\nFinally, you may want to check out a website that uses video to demonstrate how \nto do a wide range of things\u2014everything from sewing to cooking to magic tricks. The \nsite is www.videojug.com. In addition to being a great place to learn all sorts of inter -\nesting skills, the site includes video demonstrations of various social behaviors, includ -\ning making a good \ufb01rst impression, dating, hugging, kissing, complaining appropriately, \nlooking approachable, and even how to give a great handshake! Just search for the \nbehavior you want to see.\nLEARNING TO LISTEN\nCommunication is a two-way street. Listening effectively when you are in a conversa -\ntion, being interviewed, or participating in a meeting is as important as what you say. \nWhen you feel anxious, your attention tends to shift from the situation itself to your", "source": "shyness_social.pdf"}
{"id": "77a23093cd68-1", "page_content": "When you feel anxious, your attention tends to shift from the situation itself to your \nown experiences in the situation. In other words, you become aware of how you\u2019re \nfeeling, and you begin to wonder whether your anxiety symptoms are noticeable to \nthe other people in the room and whether those people are judging you negatively. \nAt the same time, you become less aware of other aspects of the situation, including \nwhat other people are saying. This lack of concentration on what others are saying \nmay reinforce your uncertainty about whether your responses are appropriate. Often, \neven when you think you are listening, you may be only partially aware of what is \nbeing said.\nThere are several costs to not listening. First, you may miss important informa -\ntion that the other person is trying to communicate. You may hear only the parts of \nthe message that are consistent with your anxious beliefs, thereby increasing your \nanxiety. For example, if you hear only your boss\u2019 negative comments and miss his or \nher praise during a performance evaluation, you will undoubtedly feel worse than if \nyou had heard the entire evaluation. Not hearing the entire message also may lead you \nto respond inappropriately, sometimes to something completely different than what \nwas actually said. Furthermore, the other person may sense that you are not listen -\ning to what is being said. As a result, you may be perceived by that person as aloof, \ndistracted, or bored by the conversation.", "source": "shyness_social.pdf"}
{"id": "1924b01076b7-0", "page_content": "Communicating More Effectively\n207Blocks to Effective Listening\nIn Messages: The Communication Skills Book,  authors McKay, Davis, and Fanning list a \nnumber of different factors that frequently interfere with our ability to listen to others \nduring conversations, meetings, arguments, and other types of social interactions. Of \nthese, \ufb01ve are especially common when people feel anxious in a social situation. These \nlistening blocks include the following:\nU\u00caComparing yourself to the other person . We all compare ourselves to others \nas a way to evaluate our own behavior and accomplishments. However, \nexcessive social anxiety may be associated with the tendency to do this \nmore often, to make unfavorable comparisons (for instance, comparisons \nwith those who are more successful on a particular dimension), and to feel \nbad after making such comparisons. This tendency to make negative com -\nparisons while conversing (for example, criticizing yourself with unspoken \ncomments such as, \u201cI\u2019m not as smart as he is\u201d or \u201cShe is more attractive than \nI am\u201d) interferes with your ability to listen to and hear what is being said.\nU\u00caFiltering what the other person says . Filtering involves listening only to \ncertain parts of what the other person is saying. In social anxiety, this can \ninvolve paying attention only to those parts of the conversation that seem \nto indicate that the other person is being critical or judgmental.\nU\u00caRehearsing what to say next . When people are overly concerned about \nsaying the right thing during conversations or meetings, they often rehearse \nmentally how they will respond to other people\u2019s comments rather than \ntruly listening to what is being said. Although you may engage in rehearsal \nto make sure you say the right thing, this practice, if used too often, may", "source": "shyness_social.pdf"}
{"id": "1924b01076b7-1", "page_content": "to make sure you say the right thing, this practice, if used too often, may \nhave the opposite effect.\nU\u00caDerailing the conversation . Derailing involves switching the topic of con -\nversation when it becomes either boring or uncomfortable. In social anxiety, \nderailing may take place when the conversation moves into anxiety-provok -\ning areas. For example, if a coworker asks you about your weekend and \nyou are embarrassed to admit that you stayed home alone all weekend, you \nmight shift the conversation back to a work-related topic, rather than dis -\nclose what you perceive to be overly personal information. Derailing can \nmake the other person feel as though you are not listening or are not inter -\nested in the conversation.\nU\u00caPlacating the other person . Placating involves agreeing with the other \nperson regardless of what he or she says in an effort to avoid potential con -\n\ufb02ict. Because social anxiety is associated with a fear of being disliked or neg -\natively judged, people who are socially anxious often go out of their way to \nagree with others. However, most people don\u2019t expect to have others agree", "source": "shyness_social.pdf"}
{"id": "49bb2f4debce-0", "page_content": "The Shyness & Social Anxiety Workbook\n208with them all the time. If you always agree with whatever is said, it may raise \nthe other person\u2019s suspicions about whether you\u2019re really listening.\nImproving Your Listening Skills\nThe authors of Messages  provide a number of suggestions for improving listening \nskills. First, they suggest that effective listening should involve active participation rather \nthan just sitting quietly and absorbing the information. Active listening involves main -\ntaining appropriate eye contact, paraphrasing what the person has said (\u201cSo, in other \nwords, what you are saying is . . .\u201d), asking for clari\ufb01cation (asking questions to help \nyou understand what was said), and providing the other person with feedback (or your \nreactions to what he or she said). Whenever possible, feedback should be immediate (as \nsoon as you understand the communication), honest (re\ufb02ecting your true feelings), and \nsupportive (in other words, gentle and unlikely to be hurtful to the other person).\nIn addition, it\u2019s important to listen with empathy . Being empathic means conveying \nthe idea that you genuinely understand the other person\u2019s message as well as the feelings \nhe or she is experiencing. As discussed in chapter 6, there are many different ways of \ninterpreting a given situation. By trying to understand another person\u2019s perspective, you \nwill be better able to listen and to communicate that fact. Note that it is not necessary \nfor you to agree with the other person\u2019s perspective\u2014just to understand it. However, \neven when someone says something that you believe to be completely incorrect, you \nprobably can identify at least a small part of the message that is true. Letting the person \nknow that you understand his or her perspective conveys empathy, even if you don\u2019t", "source": "shyness_social.pdf"}
{"id": "49bb2f4debce-1", "page_content": "know that you understand his or her perspective conveys empathy, even if you don\u2019t \nagree with the overall content of what was said.\nFinally, effective listening requires listening with openness and awareness. Openness  \ninvolves listening without trying to \ufb01nd fault. Awareness  involves (1) being aware of how \na communication \ufb01ts in with your own knowledge and experiences, and (2) being aware \nof any inconsistencies in the verbal message itself and the nonverbal aspects of the \n communication, such as tone, posture, and facial expressions.\nExercise: Effective Listening\nThe next time you\u2019re in a conversation, try some of the effective listening skills described \nabove:\n1. Make eye contact during the conversation.\n2. Paraphrase what the other person says, and ask for clari\ufb01cation if you\u2019re \nunsure about any aspect of the communication.\n3. Give feedback when appropriate, making sure that your feedback is immedi -\nate, honest, and supportive.", "source": "shyness_social.pdf"}
{"id": "344d5aa7ebbd-0", "page_content": "Communicating More Effectively\n2094. Finally, make sure that you are listening with empathy, openness, and \nawareness.\nAfter trying this exercise in a real-life situation, come back to this chapter and list on \nthe lines below any ways in which the experience was different from your usual conver -\nsations. Did the conversation last longer? Was it more gratifying? Did the other person \nrespond differently to you? Did you experience less anxiety than usual?\nNONVERBAL COMMUNICATION\nWhen you feel anxious in a social situation, you probably engage in behaviors designed \nto subtly avoid communicating with others. These may include avoiding eye contact, \nspeaking very quietly, or even avoiding the situation completely. Despite your efforts to \navoid communication, however, it\u2019s virtually impossible not to communicate. In fact, what \nyou actually say in words during a conversation makes up a very small component of the \nmessages you communicate to others. Nonverbal aspects of communication, including \nyour physical distance from others, eye contact, posture, tone of voice, and vocal volume \ncommunicate at least as much information as your verbal messages. In fact, even when \nyou completely stay away from a feared social situation, you communicate a message to \nothers. For example, if you repeatedly avoid meetings at work, others may assume that \nyou are shy, uninterested, or even unfriendly.\nDespite wanting others to respond positively, people who are shy or socially anxious \noften exhibit nonverbal behaviors that communicate to others, \u201cStay away from me.\u201d \nExamples of these closed nonverbal behaviors include leaning back or standing far away \nfrom other people, avoiding eye contact, speaking quietly, crossing your arms over your \nchest, clenching your \ufb01sts, and maintaining a serious facial expression. Although you", "source": "shyness_social.pdf"}
{"id": "344d5aa7ebbd-1", "page_content": "may believe that these behaviors serve as a form of protection in anxiety-provoking \n situations, they tend to have the opposite effect.\nInstead of protecting you from potential threat or from being judged by others, \nthese behaviors probably increase the likelihood that others will react negatively. For \nexample, at a party, people are most likely to approach someone who is smiling, making \neye contact, and talking at a reasonable volume. When someone stands far away, speaks \nquietly, and avoids eye contact, it is natural to assume that the individual is either \n uninterested in speaking or dif\ufb01cult to get to know.\nOf course, moderation is the key here. Too much eye contact can make others \nuncomfortable. In addition, someone who stands too close or smiles at inappropriate", "source": "shyness_social.pdf"}
{"id": "e56117065334-0", "page_content": "The Shyness & Social Anxiety Workbook\n210times may make others feel uneasy. Unfortunately, it is impossible to specify the appro -\npriate intensity for each of these behaviors because so many variables play a role. What \nis appropriate in one situation is not necessarily appropriate in another. For example, \nalthough it\u2019s okay to stand several inches away from a romantic partner during an inti -\nmate conversation, you probably would want to stand farther back when talking to a \ncoworker. With respect to nonverbal communication, there are differences across gender \nand across cultures. Therefore, we suggest that you experiment with using different \nnonverbal behaviors to \ufb01nd out what works best for you in the particular situations that \nyou encounter from day to day.\nClosed nonverbal behaviors  are behaviors that close the channels of communication by \nsending the message that the opportunity for contact or communication with you is unavail -\nable. Below is a list of closed nonverbal behaviors often associated with social anxiety:\nU\u00caLeaning back while sitting (vs. leaning forward)\nU\u00caStanding far away from another person (vs. standing closer)\nU\u00caAvoiding eye contact (vs. making appropriate eye contact)\nU\u00caSpeaking quietly (vs. speaking at a volume that is easily heard)\nU\u00caCrossing arms (vs. keeping arms uncrossed or making hand gestures)\nU\u00caClenching \ufb01sts (vs. keeping hands open)\nU\u00caMaintaining a serious facial expression (vs. smiling warmly)\nU\u00caSpeaking with a timid tone (vs. speaking with a con\ufb01dent tone)\nU\u00caSitting hunched over (vs. sitting up straight)\nExercise: Open Behaviors\nDo you tend to overuse any of these behaviors? If so, try to replace some of your closed", "source": "shyness_social.pdf"}
{"id": "e56117065334-1", "page_content": "behaviors with open behaviors during the course of your exposure practices over the next \nweek. Record your experiences in the provided space. For example, record whether people \nreact differently to you when you smile more, make eye contact, or speak more loudly.", "source": "shyness_social.pdf"}
{"id": "648d413528ea-0", "page_content": "Communicating More Effectively\n211CONVERSATIONAL SKILLS\nDo you often struggle to \ufb01nd things to say when making casual conversation or small \ntalk? Do you keep quiet at parties or meetings because you \ufb01nd it dif\ufb01cult to contribute \nto conversations? When you do get involved in a conversation, perhaps you \ufb01nd that \nthe discussion \ufb01zzles quickly, as you and the other person run out of things to say. In \nthis section, we discuss ways of starting and ending conversations, as well as methods \nof improving the quality of your conversations. These suggestions may be adapted for \ndifferent types of conversations, including talking to a coworker or classmate, conversing \non a date, or speaking with a stranger while waiting in line.\nKeep in mind that the suggestions in this section are not always going to work \nsmoothly. For example, if you start talking to someone in an elevator, the person may \nrespond positively or may frown and ignore you. If an individual responds negatively \nwhen you try to make contact, remember that it\u2019s not necessarily because you did some -\nthing wrong. The other person may be shy or may be concerned about his or her safety \n(having been raised never to talk to strangers). Also, it\u2019s possible that your communica -\ntion will be misunderstood. If things don\u2019t work out during a particular practice, try to \nunderstand why and to \ufb01gure out what you can do differently next time. Learning from \nyour experiences will help you to plan future practices that are more likely to work out \nsatisfactorily.\nFinally, if you want to learn more about making conversation, we recommend that \nyou read the third edition of Alan Garner\u2019s book, Conversationally Speaking: Testing New Ways", "source": "shyness_social.pdf"}
{"id": "648d413528ea-1", "page_content": "you read the third edition of Alan Garner\u2019s book, Conversationally Speaking: Testing New Ways \nto Increase Your Personal and Social Effectiveness (1997). Another excellent book on improving \nconversation skills is Talk to Me: Conversation Tips for the Small-Talk Challenged  (Honeychurch \nand Watrous 2003).\nStarting a Conversation\nAlthough getting a conversation started is sometimes dif\ufb01cult, it often becomes \neasier with practice. Opportunities to start conversations are everywhere. For example, \npeople often speak to strangers in grocery store lines and elevators, or on buses, subways, \nairplanes, and in other public places. People talk to others at parties, weddings, funer -\nals, and work functions. If you are at a party, it is perfectly appropriate to walk up to \na group of people who are already talking. After a minute or two of standing around \nwith the group, you can join in the conversation. If you are a college student, you can \nincrease your opportunities for casual conversation by always sitting in the same area of \nthe classroom so you\u2019ll have repeated exposure to some of the same students each time. \nAlso, arrive to class early so you can chat with others before class starts.\nThe topic of conversation should usually begin with something friendly and not too \npersonal, particularly if you don\u2019t know the other individual very well. You may begin \nwith a question (something like, \u201cHow was your weekend?\u201d), a compliment (\u201cI like your \nnew haircut\u201d), an observation (perhaps, \u201cI notice that you\u2019re not driving your usual car\u201d),", "source": "shyness_social.pdf"}
{"id": "f1bfe9eb9a81-0", "page_content": "The Shyness & Social Anxiety Workbook\n212or an introduction (\u201cI don\u2019t believe we\u2019ve met. My name is . . .\u201d). Other appropriate \ntopics include: hobbies, your job, a movie or TV show you recently saw, the weather, \nsomething you recently read, your vacation, a recent shopping trip or outing, and sports. \nAfter you\u2019ve been talking for a while, it may be appropriate to discuss more controversial \ntopics, such as politics, relationships, personal feelings, dif\ufb01cult family situations, and \ntopics related to sexuality. However, you should introduce topics such as these slowly, \nand gauge the other person\u2019s reactions before deciding how far to take the conversation. \nTry to avoid getting too personal, unless you know the other person well or the other \nperson is disclosing similar types of personal information. At a party or on a \ufb01rst date, \nit\u2019s \ufb01ne to talk about your work or what your parents do for a living, but it is usually best \nto stay clear of weighty topics (like a past sexual assault, a recent history of depression, \nand so on).\nImproving the Quality of Your Conversations\nHere are a few tips for improving your conversations:\nU\u00caConversations are a two-way street . It\u2019s not enough to just listen to another \nperson. Nor is it appropriate to talk only about yourself without giving the \nother person a chance to speak. Of course, there are exceptions. There are \nsome people who are very happy to have you do all the talking or allow \nthem to do all the talking. However, for most of us, a conversation is far \nmore interesting if we have the opportunity to express our own thoughts, \nfeelings, and experiences and also the chance to listen to another person\u2019s \nviews and experiences.", "source": "shyness_social.pdf"}
{"id": "f1bfe9eb9a81-1", "page_content": "views and experiences.\nU\u00caUse active listening skills . The active listening skills described earlier in the \nchapter will enhance the quality of your conversations. In particular, be sure \nto re\ufb02ect back that you are understanding what the other person is saying.\nU\u00caDisclose some (but not too much) information about yourself . As men -\ntioned earlier, the information you disclose should not be overly personal at \n\ufb01rst. Instead, you can start by talking about your weekend\u2019s activities, your \nfavorite sports team, a movie you recently saw, or a class that you\u2019re taking, \nfor example.\nU\u00caShow interest in the other person . For instance, follow up what the other \nperson says by asking for clari\ufb01cation or requesting more details.\nU\u00caTry a light touch . In some situations, it may be appropriate to touch the \nother individual (for example, a light touch on the arm). However, only use", "source": "shyness_social.pdf"}
{"id": "a031c2dda9b5-0", "page_content": "Communicating More Effectively\n213touch if it can be done naturally, in a way that doesn\u2019t seem overly forced. \nNote that the appropriate use of touch varies between men and women and \nacross cultures. It may also be frowned on in professional settings.\nU\u00caPay attention to detail . When telling stories, take your cues from others \nwhen trying to decide how much detail to include. See how detailed others \nare in their conversations, and model your own conversations after them. If \nyou notice that others are starting to look bored or look at their watches \nwhile you tell a story, take that as a sign that it\u2019s time to wrap it up. On the \nother hand, make sure your conversation is not completely devoid of details. \nEither too much detail or not enough detail can make a conversation less \nengaging.\nU\u00caGive and receive compliments . When complimenting others, make sure you \nare honest (don\u2019t say you like something if you don\u2019t), and don\u2019t overdo \nit. Although it\u2019s nice to receive a compliment from time to time, it can be \nuncomfortable to receive too many compliments or to receive compliments \nthat are felt to be undeserved. If you receive a compliment from someone \nelse, simply say thank you. Don\u2019t discount the compliment or make the \nother person feel bad for giving it.\nU\u00caPay attention to your nonverbal behaviors . For example, make eye contact \nand speak so the other person can hear you.\nAsking Questions\nAsking the other person questions will communicate that you are interested in what \nhe or she has to say. You can ask about your conversation partner\u2019s experiences (for \nexample, \u201cHow was that restaurant you went to last night?\u201d) or you can ask for the other", "source": "shyness_social.pdf"}
{"id": "a031c2dda9b5-1", "page_content": "person\u2019s reaction to something you\u2019ve said. If possible, try to use open-ended questions \nrather than closed-ended questions. A closed-ended question  is one that elicits a response \nof only one or two words. For example, the closed-ended question \u201cDid you like the \nmovie?\u201d could easily lead to responses like \u201cYes\u201d or \u201cNo,\u201d at which point you would be \nback at square one, trying to \ufb01nd another topic of conversation. Closed-ended questions \nusually begin with words like \u201care,\u201d \u201cdo,\u201d \u201cwho,\u201d \u201cwhen,\u201d \u201cwhere,\u201d and \u201cwhich.\u201d\nIn contrast, open-ended questions  usually can elicit more detailed answers. Open-ended \nquestions are more likely than closed-ended questions to generate longer and more inter -\nesting conversations. These types of question usually begin with words or phrases like \n\u201chow,\u201d \u201cwhy,\u201d and \u201cin what way.\u201d For example, the question \u201cWhat did you think about \nthe movie?\u201d draws out a more thorough response than \u201cDid you like the movie?\u201d", "source": "shyness_social.pdf"}
{"id": "d003578e3e1d-0", "page_content": "The Shyness & Social Anxiety Workbook\n214Here are some examples of closed-ended and open-ended questions:\nClosed-Ended Questions Open-Ended Questions\nU\u00caDid you have a good weekend? U\u00caWhat did you do this weekend?\nU\u00caWho is your favorite candidate? U\u00caWhat do you like about the differ -\nent candidates?\nU\u00caWhat do you do for a living? U\u00caHow did you get into your current \nline of work?\nU\u00caDo you like your psychology \nprofessor?U\u00caWhy do you like your psychology \nprofessor?\nNote that a question can be too open-ended, so that it is responded to as if it were \na closed-ended question. For example, questions like \u201cHow are you?\u201d or \u201cHow was your \nday?\u201d typically lead to a one-word response such as \u201cFine.\u201d\nEnding Conversations\nAll conversations eventually come to an end. Furthermore, in informal social situa -\ntions (at a party, on a date, on the phone), conversations almost always end because one \nor both people lose interest in what is being talked about or they reach a point at which \nthey would rather be doing something else or talking to someone else.\nIf you are especially sensitive to rejection, you may become more anxious as a con -\nversation nears its end. Or you may be hurt if you think that the other person seems less \ninterested in continuing to converse. Nevertheless, if you begin to pay attention to other \npeople\u2019s conversations, you will notice that all discussions reach a point at which there \nis little more to be said. Sometimes this point is reached in a few seconds. Other times, \nit may take a few minutes or even an hour for a particularly interesting conversation to", "source": "shyness_social.pdf"}
{"id": "d003578e3e1d-1", "page_content": "it may take a few minutes or even an hour for a particularly interesting conversation to \nend. Running out of things to talk about is not a failure and does not mean that you are \nboring. It is a normal feature of all conversations.\nTypically, people try to \ufb01nd graceful ways to get out of conversations that have \nrun their course. At a party, you might excuse yourself to re\ufb01ll your drink or visit the \nbathroom. Or, it may be appropriate to mention politely that you need to catch up with \nanother person at the party. In a work setting, people often end the conversation with \na reference to work (for instance, \u201cWell, I need to get back to work\u201d) or a pledge to \ncontinue the conversation later (\u201cPerhaps we can have lunch together some time soon\u201d). \nOften, simply saying something like, \u201cIt\u2019s been nice talking to you, but I need to run\u201d is \nsuf\ufb01cient. If you have enjoyed the conversation, be sure to let your conversation partner \nknow that (\u201cI\u2019ve really enjoyed talking to you. I hope we get a chance to talk again\u201d).", "source": "shyness_social.pdf"}
{"id": "49eca1d08bc7-0", "page_content": "Communicating More Effectively\n215Exercise: Conversations\nTry using some of these conversational strategies the next time you\u2019re having a conversa -\ntion. If you rarely encounter situations that allow for conversation, you may need to go \nout of your way to seek out such situations. During the practice, pay special attention to \nusing the strategies for starting the conversation, improving the quality of the conversa -\ntion, and ending the conversation. In the spaces below, record your experiences after \nusing the relevant strategies for each phase of the conversation.\nStarting the conversation: \nImproving the quality of the conversation: \nEnding the conversation: \nJOB INTERVIEWS\nMost people feel somewhat nervous when being interviewed for a job. In fact, showing \nno signs of anxiety could work against you in some interview situations. Not showing \nany signs of anxiety during an interview might be interpreted by the interviewer as a sign \nthat you are overcon\ufb01dent or disinterested. But if you\u2019re particularly anxious in social \nsituations, interviews may be even more anxiety-provoking for you than they are for the \naverage person. Chapter 6 reviewed strategies for changing the beliefs that contribute to \nyour anxiety in situations such as interviews. Chapters 7 and 8 recommended practicing", "source": "shyness_social.pdf"}
{"id": "3d661deaf90e-0", "page_content": "The Shyness & Social Anxiety Workbook\n216exposure to interviews (using both real interview practices and role-play simulations) \nas a strategy for learning to become less anxious. In this section, we provide additional \nsuggestions for improving interview skills. These suggestions are meant to be used along \nwith the cognitive and exposure-based techniques discussed in earlier chapters.\nEssentially, being prepared for an interview involves knowing what to do before \nthe interview, how to behave during the interview, and what to do when the interview \nis over. We provide suggestions for each of these interview phases. For a more detailed \ndiscussion of this topic, we suggest reading Messages: The Communication Skills Book . There \nare several other excellent resources on interviewing for jobs listed in the recommended \nreadings section at the end of this book.\nPreparing for the Interview\nHere are some suggestions for preparing for an interview. These are all things to do \nbefore you get there:\nU\u00caBefore the interview, practice interviewing with friends and family members. \nAlso, practice interviewing for other jobs that are of less interest to you. As \nwe discussed in chapters 7 and 8, practicing being interviewed will help to \ndecrease your anxiety when you are in the actual situation.\nU\u00caKeep the situation in perspective. Remember that it\u2019s only an interview. If it \ndoesn\u2019t work out, there will be other opportunities. Think of the interview \nas a learning experience or an opportunity to improve your interviewing \nskills.\nU\u00caTake time to understand the purpose of the interview, learn who will be \ninterviewing you, what the structure of the interview will be, and how long \nthe interview will run. If possible, \ufb01nd out the interviewer\u2019s name and make \nsure you remember it. If that\u2019s not possible, when the interviewer introduces", "source": "shyness_social.pdf"}
{"id": "3d661deaf90e-1", "page_content": "sure you remember it. If that\u2019s not possible, when the interviewer introduces \nhimself or herself to you, pay attention and try to use the name when you \nsay good-bye.\nU\u00caLearn as much as possible about the organization or company and about \nthe person who is interviewing you. If the organization has a website, make \nsure you study it carefully. You may even be able to learn about your inter -\nviewer beforehand. Being knowledgeable about the organization during the \n interview will show that you really are interested in the position.\nU\u00caTake some time to identify your strengths and have a good idea of what \nyou can contribute to the organization, in case you\u2019re asked. You may want \nto take some notes with you to prevent forgetting something that you want \nto mention.", "source": "shyness_social.pdf"}
{"id": "321c1aa196bc-0", "page_content": "Communicating More Effectively\n217U\u00caPlan a response in case you are asked about your weaknesses or limitations. \nThere is no need to list every \ufb02aw that comes into your mind. Instead, you \ncan mention one or two limitations, phrasing them in such a way that they \nare unlikely to be viewed as a problem that cannot be solved. For example, \nyou can choose to focus on a minor limitation in your experience or train -\ning that is unlikely to be viewed as serious. Or, you can de\ufb02ect the ques -\ntion by talking about a limitation that you had in the past that is no longer \na problem (something like, \u201cWhen I \ufb01rst started my previous job, I didn\u2019t \nhave much experience working with computers. However, over the past few \nyears, I got a lot of computer experience, so that\u2019s not an issue anymore\u201d). \nHowever, don\u2019t emphasize limitations that could be viewed as weaknesses \nin your character or a re\ufb02ection of your work habits (for example, \u201cI get \nangry easily\u201d or \u201cI\u2019m very unorganized\u201d), since a potential employers may \nview these as harder to change. Also, avoid answering a question about your \nweaknesses with a response about how you work too hard (for instance, \u201cI \ntend to work too hard, so I need to remind myself to take breaks\u201d). This is \na very clich\u00e9 response that employers will see through (no employer would \nsee that as a weakness). For more ideas on how to answer dif\ufb01cult interview \nquestions, check out Ron Fry\u2019s book, 101 Great Answers to the Toughest Interview \nQuestions (2007).\nU\u00caPrepare at least ten questions you can ask during the interview. Write them", "source": "shyness_social.pdf"}
{"id": "321c1aa196bc-1", "page_content": "U\u00caPrepare at least ten questions you can ask during the interview. Write them \ndown so you won\u2019t forget. For example, you should consider asking ques -\ntions about the types of responsibilities that you are likely to have, the hours \nyou will be expected to work, who you will be working with, and the struc -\nture of a typical day. Questions about salary, vacations, and bene\ufb01ts gener -\nally should be asked after you have received an offer, although for certain \npositions it may be appropriate to ask these questions during the interview, \nparticularly if the interviewer brings these topics up.\nU\u00caBring extra copies of your r\u00e9sum\u00e9 and other supporting documents, in case \nthe interviewer does not have easy access to these materials or wishes to \nshare your r\u00e9sum\u00e9 with someone else in the organization.\nDuring the Interview\nSo, your interview day has arrived. Here are some suggestions for how to make the \nmost of it:\nU\u00caUnder no circumstances should you be late. Give yourself enough time to \nget to the interview and arrive a bit early. If you are unfamiliar with where \nthe interview is being held, make sure to visit the site the previous day so \nyou know how to get there.", "source": "shyness_social.pdf"}
{"id": "224ca17b90f7-0", "page_content": "The Shyness & Social Anxiety Workbook\n218U\u00caYour appearance is important. Make sure that you are dressed attractively \nand that your hair is neat. Note that appropriate attire for one job interview \nmay be quite inappropriate for another type of job. If you\u2019re not sure what \nto wear, err on the side of dressing in a more conservative and professional \nmanner.\nU\u00caRemember to use some of the strategies discussed earlier in this chapter. For \nexample, really listen to what the interviewer asks or tells you. Pay attention \nto your nonverbal communication and try to maintain eye contact.\nU\u00caBe courteous, polite, and tactful. Remember to say please and thank-you. \nDon\u2019t disparage the organization, the interview process, or the person inter -\nviewing you. In fact, avoid appearing overly negative about previous jobs \nand employers, even if you were unhappy in a previous position.\nU\u00caAppear \ufb02exible and willing to compromise. For example, if the hours aren\u2019t \nperfect, let the interviewer know that you will do what you can to accom -\nmodate the schedule. After you get the offer, you can renegotiate the hours. \nIf it doesn\u2019t work out to your satisfaction, you can always turn down the \nposition.\nU\u00caAsk questions. A job interview has two purposes: (1) to allow the interviewer \nto decide about you and (2) to give you an opportunity to decide whether \nyou want to work for that particular organization. Make sure you ask ques -\ntions during the interview. Not only will asking questions help you to \ufb01nd \nout more about the position, but it will also convey to the interviewer that \nyou are serious about the job.", "source": "shyness_social.pdf"}
{"id": "224ca17b90f7-1", "page_content": "you are serious about the job.\nU\u00caIn general, be yourself during the interview and answer questions hon -\nestly. However, don\u2019t offer too much unnecessary personal information. For \nexample, if the interviewer asks whether you are nervous, it\u2019s okay to say that \nyou are feeling a bit anxious. On the other hand, there is no need to provide \ndetails about any personal dif\ufb01culties or stresses that you may be experienc -\ning, including frequent panic attacks, depression, or marital problems.\nU\u00caAt the end of your interview, ask the interviewer what the next steps are. \nFor example, if the organization will be interviewing other candidates, when \ncan you expect to hear their decision? Is there likely to be a second or third \ninterview for the \ufb01nalists? \nAfter the Interview\nYour work isn\u2019t quite over once the interview ends. Here are a couple of suggestions \nfor things to do after the interview has ended:", "source": "shyness_social.pdf"}
{"id": "be41c95f03d0-0", "page_content": "Communicating More Effectively\n219U\u00caAfter the interview, send a letter thanking the interviewer for his or her \ntime.\nU\u00caTake some time to think about what went well during the interview and \nwhat you might have preferred to do or say differently. This information will \nbe helpful for planning your next set of interviews if you don\u2019t get the job.\nASSERTIVE COMMUNICATION\nThis section describes three ways of communicating: passive communication, aggressive \ncommunication, and assertive communication. Passive and aggressive styles of commu -\nnication rarely have the desired effect; assertive communication is more likely to get \npositive results. This section will help you to understand the differences among these \nthree types of communication and will provide you with an introduction to methods for \nensuring that you communicate assertively.\nPassive Communication\nGenerally, shyness and social anxiety are associated with a tendency to communicate \npassively. Passive communication involves expressing one\u2019s needs indirectly, often in a \nquiet voice, and perhaps with frequent pauses and hesitations. Passive communication \nplaces the other person\u2019s wants, needs, and desires ahead of your own. This style of com -\nmunicating is often associated with a strong desire to avoid any possibility of offending \nor inconveniencing the other individual. However, because your message is not commu -\nnicated directly, the other person may never receive the message that you intended to \ncommunicate. Therefore, passive communication closes the channels of communication \nand may cause you to feel hurt and resentful. In fact, this resentment eventually may put \nyou at risk for communicating in an aggressive manner later on. For example, a passive \nway of inviting someone to socialize is the vague statement, \u201cWe should get together \nsometime.\u201d\nAggressive Communication", "source": "shyness_social.pdf"}
{"id": "be41c95f03d0-1", "page_content": "sometime.\u201d\nAggressive Communication\nAggressive communication involves expressing your feelings, needs, or wants at the \nexpense of another\u2019s feelings, needs, and wants. Aggressive communication tends to be \njudgmental, critical, and accusatory in content and tone. Like passive communication, \nthis style of responding closes the channels of communication and can result in hurt feel -\nings, grudges, anger, and alienation from the other person. An example of an aggressive \nway of asking someone to socialize is the statement, \u201cIf you cared about me and weren\u2019t \nso sel\ufb01sh, you would invite me to get together with you more often.\u201d", "source": "shyness_social.pdf"}
{"id": "9d413527cb0c-0", "page_content": "The Shyness & Social Anxiety Workbook\n220Assertive Communication\nOften, people assume that passive and aggressive styles of communicating are their \nonly two options. However, there is a third option. In contrast to aggressive and passive \nstyles of communicating, assertive communication takes into account one\u2019s own feelings, \nneeds, and wants, as well as those of the other person. Assertive communication has \nmany of the features of good communication, including a tendency to be direct, clear, \nand immediate. An example of an assertive way to invite someone to socialize is the \nquestion, \u201cWould you like to see a movie with me this weekend?\u201d\nIn addition, assertive communication should include actively listening to the other \nperson\u2019s perspective (including trying to hear and understand the other person\u2019s point of \nview, validating the other person\u2019s feelings, asking for clari\ufb01cation, and so on). Although \nassertive communication does not guarantee that you will get your way, compared with \naggressive and passive styles of communication, assertive statements are more likely to \nkeep the channels of communication open and to maximize the chances of reaching a \nmutually satisfactory resolution.\nDealing Assertively with Con\ufb02ict Situations\nIf your goal is to convince someone else to change his or her behavior, an appropri -\nate way of doing that is to make sure that your message is neither passive nor aggressive. \nInstead, you should try to communicate your message in a way that is factual, direct, \nand empathic.\nBegin by describing your observations regarding the situation. Observations re\ufb02ect \nyour perspective regarding the facts, rather than your interpretations of those facts. \nObservations should be based on reality and therefore are usually very dif\ufb01cult to argue", "source": "shyness_social.pdf"}
{"id": "9d413527cb0c-1", "page_content": "Observations should be based on reality and therefore are usually very dif\ufb01cult to argue \nwith. For example, \u201cYou arrived home too late\u201d is not an observation because whether \nthe person\u2019s arrival is \u201ctoo\u201d late is open to interpretation. However, the statement \u201cYou \narrived home an hour later than you said you would\u201d is an observation (assuming it\u2019s \ntrue) and is therefore less likely to lead to a defensive response from the other person.\nAfter describing your observations, the next step is to describe your feelings about \nthe situation. Feelings are emotions such as anger, anxiety, worry, and sadness. Feelings \nare not thoughts. For example, the statement \u201cI feel that you should not be late\u201d is not \nreally a feeling statement. In contrast, \u201cI feel hurt and worried when you arrive home \nlater than you say you will\u201d is a feeling statement. As is the case with communicating \nyour observations, it\u2019s dif\ufb01cult to argue with a feeling statement. Only you know how \nyou really feel.\nFinally, it is important to communicate the ways in which you would like things to \nchange. To follow the earlier example through, you might say, \u201cI would like you to phone \nme if you are going to be more than thirty minutes late.\u201d", "source": "shyness_social.pdf"}
{"id": "bfe4a43487ce-0", "page_content": "Communicating More Effectively\n221After you communicate your message in terms of these three components, you need \nto make sure that you give the other person a chance to express his or her perspective \non the situation. Make sure you take advantage of the active listening skills that were \ndiscussed earlier in this chapter.\nIn addition to these basic assertiveness skills, there are a number of other strategies \nthat may help you to deal with con\ufb02ict situations:\nU\u00caMake sure that you choose an appropriate time to talk about the situation. \nDon\u2019t put it off inde\ufb01nitely. On the other hand, don\u2019t talk about the issue \nduring the height of your anger. Also, don\u2019t insist that the issue be discussed \nright away if the other person is busy or unwilling to talk. Sometimes it\u2019s \nbest to schedule a meeting at a mutually convenient time and to discuss the \nmatter then.\nU\u00caMake sure that you challenge the beliefs that contribute to your anxiety, \nanger, or hurt feelings. As discussed in chapter 6, our feelings are in\ufb02uenced \nby our beliefs, and our beliefs may be exaggerated or unrealistic at times. \nIn other words, the situation may not matter as much as you think it does. \nWhen discussing the situation with the other person, try to maintain your \ncool by thinking about the situation realistically.\nU\u00caBefore confronting a situation, decide whether it is worth it. Is it a situation \nthat matters? Will it take care of itself, even if you don\u2019t say anything? For \nexample, if your dif\ufb01cult neighbor is moving away next week, perhaps it\u2019s \nnot important to complain about the way he or she maintains the lawn.\nU\u00caTry bouncing your thoughts off a neutral third party. Hearing another per -", "source": "shyness_social.pdf"}
{"id": "bfe4a43487ce-1", "page_content": "U\u00caTry bouncing your thoughts off a neutral third party. Hearing another per -\nson\u2019s views regarding the issue may help you to see things in a different \nway. This can be particularly useful to determine whether your expectations \nabout the situation are distorted.\nU\u00caTry to understand the other person\u2019s perspective. Like you, the other indi -\nvidual is just trying to survive the best way that he or she can. Hostility \nand anger often are triggered by feelings of threat or hurt. If you develop an \nempathic understanding of the other person\u2019s perspective and beliefs, you \nwill have a greater chance of \ufb01nding a compromise and resolving the con -\n\ufb02ict, particularly if the other person can see that you are genuinely trying \nto understand.\nU\u00caConsider writing a letter to the other person. Sometimes it\u2019s easier to com -\nmunicate your thoughts and feelings in writing. However, even in a letter, \nyou should use an assertive communication style rather than a passive or \naggressive one. It is usually best not to use e-mail in these situations.", "source": "shyness_social.pdf"}
{"id": "342c402c4a68-0", "page_content": "The Shyness & Social Anxiety Workbook\n222MEETING NEW PEOPLE, MAKING FRIENDS,  \nAND DATING\nThis section describes ways of improving the skills that are important for meeting \nnew people and developing new relationships. The topics covered include suggestions \nfor where to meet new people and ways to deal with certain stresses associated with \n developing relationships, such as the possibility of being rejected.\nPlaces to Meet New People\nIn a survey of more than 3,000 Americans, Laumann, Gagnon, Michael, and Michaels \n(1994) studied the ways and places in which people meet. Among married people, the \nways that individuals met their spouses are shown by percentages as follows:\nWay of Meeting     Percent*\nIntroduction by a friend    35%\nIntroduction by self    32%\nIntroduction by a family member   15%\nIntroduction by a coworker     6%\nIntroduction by a classmate      6%\nIntroduction by someone else    2%\nIntroduction by a neighbor     1%\n*Note: The numbers do not add up to 100 percent because a small number of people gave multiple \nanswers.\nIn the same survey, the places where married individuals met their spouses were \nbroken down into percentages as follows:\nLocation of Meeting    Percent\nSchool      23%\nWork      15%\nParty      10%\nPlace of worship (e.g., church)    8%\nBar        8%\nGym or social club      4%\nPersonal ad       1%\nVacation       1%\nElsewhere      30%", "source": "shyness_social.pdf"}
{"id": "d0d96976e2b5-0", "page_content": "Communicating More Effectively\n223The statistics were similar for people in unmarried partnerships (couples cohabit -\ning, couples in long-term partnerships, and couples in short-term partnerships), although \nsome of the numbers were different in these other groups. For example, compared with \nmarried people, unmarried people in short-term relationships were more likely to have \nmet their partners at a bar (17 percent) or a party (25 percent) and less likely to have \nmet them at a place of worship (1 percent). Note that this survey was conducted before \nthe Internet boom, so it doesn\u2019t include information about online dating. We will return \nto this topic shortly.\nThere are many other locations where it can be relatively easy to develop new \nfriendships or to meet a potential partner. Some examples include the following: through \na hobby (for example, joining a photography club or a theater group), getting involved in \na sport (joining a bowling league, a running club, or a hiking group), getting in shape (for \ninstance, lifting weights in a gym, joining an aerobics class, taking swimming lessons), \ntaking dance classes, volunteering for an organization, forming a book club or reading \ngroup, attending public lectures, taking a part-time job, enrolling in an adult education \ncourse, or traveling (perhaps with a group).\nThe best way to meet new people is to do the things that you enjoy doing. That \nway, you are likely to meet people who enjoy the same things you do. For example, if \nyou don\u2019t enjoy drinking alcohol or spending time in bars, you should think twice about \ntrying to meet people there. At a bar, you are likely to meet people who enjoy going to \nbars. You should also keep in mind the types of people you are likely to meet by getting", "source": "shyness_social.pdf"}
{"id": "d0d96976e2b5-1", "page_content": "involved in a particular activity. For example, if you want to meet people close to your \nown age, try to get involved in activities that attract people in your age group.\nIt\u2019s not enough just to be around other people. To meet them, it will be necessary \nto take social risks in the situation. For openers, you should maintain eye contact, make \na point of saying hello, and be sure to smile from time to time. Casual contact is more \nlikely to develop into a friendship or relationship if you purposely engage in conversa -\ntion. As you get to know someone, you will need to take bigger risks such as asking that \nperson to meet you for coffee, go to a movie, or join you for a day\u2019s outing to a park or \na museum.\nMeeting People Online\nInternet dating is a very popular way to meet people. The Internet Dating Guide  ( www  \n.theinternetdatingguide.com) reports that about 30 percent of American singles \nhave used matchmaking sites. According to Online Dating Magazine  (www.onlinedating  \nmagazine.com), twenty million Americans visit an online dating service each month, \n120,000 marriages per year occur as a result of an online dating service, and about a \nthird of Americans know someone who has used an online dating service. The Internet is \nalso a great source of information about ways for singles to meet. Simply enter the name \nof your city and the word \u201csingles\u201d into a search engine (for example, Google), and you", "source": "shyness_social.pdf"}
{"id": "1439150c369d-0", "page_content": "The Shyness & Social Anxiety Workbook\n224will likely come up with all sorts of ideas, ranging from \u201cspeed dating\u201d groups to singles \ntravel opportunities, personal ad listings, and social events.\nIn addition to online dating, the Internet is a popular way to meet new friends. \nAn anonymous survey of 191 college students (Knox et al. 2001) found that friendship \n(as opposed to dating) was the most important reason for using the Internet among \nthis group. In this survey, 60 percent of respondents reported that they had success -\nfully established an online friendship, and about half reported being more comfortable \nmeeting people online than in person. However, note that 40 percent of people reported \nhaving lied online! More recently, online social networking sites like Facebook.com and \nMySpace .com have become popular ways to meet friends.\nIt is important for you not to use online relationships as a replacement for in-person \nrelationships. Rather, you should view online relationships as a stepping stone toward \nmeeting people in person. The recommended readings section at the end of the book \nprovides additional resources on online dating.\nDating Skills\nRegardless of how it may seem, there are lots of potential partners out there, regard -\nless of whether you are old or young, male or female. Furthermore, the idea that there \nis only one person out there who is your soul mate is a myth. There are many different \npeople who are potentially excellent partners, each having very different qualities to \nbring to a relationship. Although it may sound like a clich\u00e9, it is often true that someone \ncomes along when you least expect it, and often it occurs when you\u2019re not even looking. \nSo relax. Rushing the process can lead to feelings of disappointment or failure when a", "source": "shyness_social.pdf"}
{"id": "1439150c369d-1", "page_content": "So relax. Rushing the process can lead to feelings of disappointment or failure when a \nhoped-for relationship doesn\u2019t work out. There are several excellent published guides \nto dating, a number of which are listed in the recommended readings at the end of the \nbook. \nPREPARATION\nThe \ufb01rst step in dating is preparation. What does preparation in this context mean? \nIt means you \ufb01gure out what you\u2019re looking for. What is the purpose of your search? \nAre you looking for a serious relationship, marriage, and children? Or are you looking \nfor a sexual partner? Companionship? A way to alleviate boredom? The purpose of the \nrelationship will in\ufb02uence what kind of person you will seek and attract. For example, if \nyou are looking for excitement, meeting someone who is aloof, mysterious, and gorgeous \nmay be your aim. On the other hand, if you want a more serious relationship, you should \nchoose to emphasize qualities that will continue to be important to you after the thrill \nof a new relationship wears off, like a sense of humor, shared values, kindness, honesty, \nstability, responsibility, and respect.\nDespite the saying \u201copposites attract,\u201d the clich\u00e9 \u201cbirds of a feather \ufb02ock together\u201d \nis probably closer to the truth. Generally, research in social psychology has found that", "source": "shyness_social.pdf"}
{"id": "626791a8f43d-0", "page_content": "Communicating More Effectively\n225people are most attracted to those who are similar to them with respect to values, appear -\nance, interests, and other attributes. Being aware of your own interests and attributes will \nhelp you to know what you are looking for in another person. In addition, being the type \nof person who you would like to meet will help you to attract that person. To meet the \nright person, you need to make a point of being in places where that person is likely to \nbe. For example, if you\u2019re interested in meeting someone who loves reading, then make a \npoint of spending time in the library, visiting bookstores, or attending book signings.\nNETWORKING \nOne very helpful activity for meeting new people is called networking. Networking \ncan be de\ufb01ned as an exchange of information or services among individuals or groups. \nAs we mentioned earlier, more than two thirds of married people are introduced to their \nspouses by a third person (Laumann et al. 1994). Therefore, let your friends and family \nknow that you are interested in meeting someone. If nothing romantic develops, you may \nadd to your circle of friends. By adding new friends (without actually giving up on old \nfriendships), you will increase your chances of \ufb01nding a partner.\nFIRST DATES \nWhen you do meet someone who interests you, the initial date can be quite infor -\nmal. For example, you might go for a walk during a break at work, run an errand together \nbetween classes, or offer the person a ride home. After you\u2019ve had more contact with \nthe person, you could suggest a more formal outing, like going out for lunch or dinner, \nseeing a concert or movie, or visiting a gallery or museum. If you are a student, you", "source": "shyness_social.pdf"}
{"id": "626791a8f43d-1", "page_content": "might suggest taking a class with the other person to increase your chances of having \nrepeated contact.\nOn your date, pay attention to small details, especially your physical appearance and \nhygiene. Dress appropriately for the situation. Wear clothes you like, but err on the side \nof conservative or classic fashions if you are unsure about the other person\u2019s taste. In \nother words, don\u2019t wear your most outrageous out\ufb01t on a \ufb01rst date.\nREJECTION \nBe prepared for rejection. Much more often than not, a particular dating situation \ndoes not lead to a long-term relationship. It\u2019s normal for one person to be more inter -\nested in pursuing a relationship than the other person is. If the other individual ends \nup not wanting to continue the relationship, make sure that you keep the rejection in \nperspective (see chapter 6 for suggestions). A rejection does not mean that there is \nsomething wrong with you or that going out on dates will never lead to a long-term \nrelationship. Rather, rejection speaks more to the \ufb01t between you and the speci\ufb01c person \nwith whom things didn\u2019t work out. Experiencing some form of rejection is a necessary \npart of dating. The more dating experiences you seek out, the more rejection you will", "source": "shyness_social.pdf"}
{"id": "87554d9f22a5-0", "page_content": "The Shyness & Social Anxiety Workbook\n226experience. However, increasing the frequency of your dates will also provide opportu -\nnities to improve your dating skills and increase the likelihood of developing a positive \nrelationship in the future.\nPRESENTATIONS AND PUBLIC SPEAKING SKILLS\nThis section provides a basic primer on public speaking and giving presentations. In \nparticular, it includes suggestions for preparing for presentations or talks and describes \nways to improve the quality of your presentations.\nFor a more detailed treatment of this topic, we suggest that you check out the rec -\nommended readings on public speaking at the end of this book. Although the emphasis \nin most of these books is on business presentations, many of the skills suggested apply \nto other types of presentations as well, such as giving a speech at a wedding or party. In \naddition to providing suggestions for how to organize and deliver presentations, most of \nthese recommended books also provide ideas for managing anxiety during presentations. \nOne that provides an excellent mix of information on presentation skills and managing \nanxiety is The Con\ufb01dent Speaker: Beat Your Nerves and Communicate at Your Best in Any Situation  \n(Monarth and Kase 2007).\nPreparing for Presentations\nPreparing for presentations involves seven important steps: (1) identifying the \npurpose of the presentation, (2) determining the nature of the audience, (3) deciding \nupon the subject matter, (4) organizing the presentation, (5) making your talk interesting \nand compiling supporting materials, (6) rehearsing the presentation, and (7) managing \nyour anxiety. \nSTEP 1: DETERMINING THE PURPOSE OF THE PRESENTATION \nBefore preparing a lecture or speech, you must \ufb01rst be clear about the purpose \nof the presentation. Essentially, presentations can have one or more of the following", "source": "shyness_social.pdf"}
{"id": "87554d9f22a5-1", "page_content": "of the presentation. Essentially, presentations can have one or more of the following \nfunctions:\nU\u00caTo persuade . For example, a presentation may be designed to sell a particu -\nlar product or to convince a group of coworkers to change a procedure in \nthe workplace.\nU\u00caTo explain . Examples include a half-day orientation meeting to explain \ncompany procedures to new employees, a lecture designed to teach a complex \ntopic to college students, or a seminar to provide  in-depth  information to \ncolleagues about a particular subject.", "source": "shyness_social.pdf"}
{"id": "89bb24f03cb0-0", "page_content": "Communicating More Effectively\n227U\u00caTo instruct . These may include presentations regarding how to perform a \ntask (like how to use a new computer program) or how to develop a new \nskill (for example, learning to dance).\nU\u00caTo brief . Some presentations are designed to brief an audience regarding \nsome matter. For example, this may include a four-minute presentation to \nupdate management about the status of union negotiations or to brief your \ncustomers about changes in the price of a product.\nU\u00caTo entertain . Examples of presentations designed to entertain include theat -\nrical presentations (for instance, stand-up comedy) and sometimes speeches \nat weddings, anniversaries, or parties.\nSTEP 2: DETERMINING THE NATURE OF THE AUDIENCE\nBefore planning a presentation in detail, it is helpful to know something about the \nnature of your audience. In some cases, you may even need to ask the audience questions \nabout their background at the start of the presentation and adapt your style or content \nto meet their needs. Some questions that are helpful to consider include the following:\nU\u00caHow big is the audience?\nU\u00caWhat is the likely composition of the audience (factors such as age, gender, \nprofessional background)?\nU\u00caWhat is the audience expecting?\nU\u00caHow much does the audience already know? What do they still need to \nlearn?\nU\u00caWhy is the audience attending the presentation\u2014because they have to or \nbecause they want to?\nSTEP 3: DECIDING UPON THE SUBJECT MATTER\nBefore giving your presentation, you should have an idea of the main message that \nyou want to convey. In most cases, the main point of the presentation should be simple", "source": "shyness_social.pdf"}
{"id": "89bb24f03cb0-1", "page_content": "you want to convey. In most cases, the main point of the presentation should be simple \nand clear. The audience should be aware of the key points that you plan to make so that \nthe content of the presentation can be understood in the proper context. In most cases, \nit\u2019s helpful to pique the group\u2019s interest (perhaps with a joke, anecdote, or illustration) \nearly in the talk. If the purpose of your presentation is to persuade the audience about \nsome issue, you should ensure that you have gained their con\ufb01dence (for example, by \nmaking the members of the audience aware of your expertise and credentials). Also, \npersuasive presentation should include speci\ufb01c instructions on how to implement the \nsuggestions you provide (for example, where to obtain the product you are selling).", "source": "shyness_social.pdf"}
{"id": "ddb307f4a84d-0", "page_content": "The Shyness & Social Anxiety Workbook\n228STEP 4: ORGANIZING THE PRESENTATION\nOne of the most common suggestions made to people who prepare presentations is \nto pay close attention to the three phases of the talk: the introduction, the main body \nof the talk, and the conclusion. The introduction  should include an overview of the pre -\nsentation so audience members know what to expect. The main body  of the presentation \nis where you discuss the main content of the talk, with all of the important details. At \nthe conclusion , you should provide a brief summary, as well as some interpretations and \n inferences about the content (for instance, why the presentation was important).\nIf possible, your presentation should be organized so it tells a story. For example, \nbefore describing a new method of performing some task, you might provide the audi -\nence with a history of how that particular task has been performed in the past so they \nhave a context in which to understand the new information. Or, the presentation can \nbe laid out so that a series of problems are described, each followed by one or more \nsolutions.\nSTEP 5: MAKING THE PRESENTATION INTERESTING\nIn addition to making sure your main points are conveyed to the audience, it is \nimportant that they are conveyed in a way that is interesting. To help you do this, \nconsider strategies like humor, analogies, personal stories, examples, illustrations, and \nrelevant statistics. Be careful not to use humor that could offend audience members. \nYou never know who is in your audience and whether their backgrounds, beliefs, or \nexperiences might cause them to take a joke the wrong way. Another strategy is to \ninvolve the audience members in some way. For example, you might ask them questions", "source": "shyness_social.pdf"}
{"id": "ddb307f4a84d-1", "page_content": "involve the audience members in some way. For example, you might ask them questions \nor encourage them to ask you questions during your presentation. Or you could have \nthem do something (demonstrate the skill you are trying to teach, complete a survey \nor take a test, and so on). Supporting materials can be another useful way to bring your \npresentation to life.\nSupporting materials.  Supporting materials often take the form of visuals (for example, \nPowerPoint slides and other projected images, videos, white boards, \ufb02ip charts, CD \nROMs, and so on). These visuals can include text, photos, illustrations, cartoons, graphics, \nand maps. Here are a few suggestions to keep in mind regarding supporting materials:\nU\u00caIf you are going to use cartoons, make sure they are funny. Ask some \nfriends, family members, or coworkers for their opinions about the cartoons \nyou intend to use.\nU\u00caIn some cases, it may be helpful to have props. For example, if you mention \nparticular books in your presentation, have copies with you for audience \nmembers to look at. If you are describing a product, bring it with you and \ndisplay it during the presentation.", "source": "shyness_social.pdf"}
{"id": "cd9d64981618-0", "page_content": "Communicating More Effectively\n229U\u00caIf possible, provide handouts containing copies of your slides and overheads \nso that audience members can listen to you instead of having to take notes. \nAudience members generally appreciate getting handouts.\nU\u00caMake sure that your slides and overheads are attractive and that the type is \nlarge enough to be seen from the back of the room.\nU\u00caAvoid the temptation to have too much information on your slides and \noverheads.\nSTEP 6: REHEARSING THE PRESENTATION\nIf at all possible, rehearse your presentation beforehand. There are several ways \nof rehearsing. Ideally, you can rehearse in front of an audience of friends, family, or \ncoworkers, preferably in a location similar to where the actual talk will be held. Ask your \nrehearsal audience for feedback, and make changes to the presentation accordingly. If \nyou cannot rehearse in front of a live audience, try rehearsing in front of a video camera \nor camcorder and watch the recording afterward. If that\u2019s not possible, practice out loud \nin front of a mirror. As you become more experienced in giving presentations, practicing \nbeforehand will become less important.\nSTEP 7: MANAGING YOUR ANXIETY\nPreparing for a presentation should also include strategies for managing your anxiety. \nBefore the presentation, make sure that you have used the cognitive strategies (chapter \n6) to challenge your anxious thoughts. In addition, use the exposure-based strategies \n(chapters 7 through 9) to confront your fears whenever possible. When you\u2019re actu -\nally in the situation, make sure that your breathing is slow and regular. Overbreathing \nor holding your breath will increase your anxiety symptoms. Don\u2019t \ufb01ght your fear. Just", "source": "shyness_social.pdf"}
{"id": "cd9d64981618-1", "page_content": "let the symptoms happen. Fighting your fear is likely to cause anxiety symptoms to \nintensify. It\u2019s okay to be nervous during a presentation. In fact, audience members often \nexpect it. Depending on the nature of the presentation, it may even be helpful to tell \nthe audience you are feeling nervous. Saying so may help you to calm down, and it very \nlikely will help to win the audience over to your side.\nDelivering the Presentation\nHere is a list of suggestions to keep in mind when you are giving a presentation.\nU\u00caPay attention to the way you deliver your speech. Before the talk, check \nany pronunciations you\u2019re not sure about. Make sure that your voice does \nnot drop off at the end of your sentences. Be sure you are projecting at a \nreasonable volume (imagine you are delivering your speech to the back wall", "source": "shyness_social.pdf"}
{"id": "ddc66e5cc3ba-0", "page_content": "The Shyness & Social Anxiety Workbook\n230of the room). Speak crisply and pronounce your words clearly. Avoid saying \n\u201cuh\u201d and \u201cum.\u201d Finally, avoid speaking too quickly. Going too fast is one of \nthe most common mistakes people make during presentations, particularly \nwhen they are feeling anxious.\nU\u00caMake eye contact with the audience members during the talk.\nU\u00caTry to move around when you are speaking. Walk around the front of the \nroom rather than staying planted at a podium. Don\u2019t put your hands in \nyour pockets. Instead, gesture with your hands to emphasize key points. \nHowever, keep your hands away from your face and hair.\nU\u00caPresentations are often less interesting when they are read verbatim. If you \nread a presentation word for word, you also run the risk of panicking if you \nlose your place. Instead, we recommend speaking from a detailed outline \nwith lots of headings, bullets, and so on. An outline will make sure that all \nthe information you need is available and easy to access, even if you lose \nyour place. It will also force you to be somewhat spontaneous during the \npresentation. If the thought of not reading your speech is too scary, another \noption is to bring both an outline version and a fully written version. If \nnecessary, you can switch to reading your presentation if using the outline \nalone doesn\u2019t work.\nU\u00caDon\u2019t talk down to your audience. They probably know more than you \nthink they do. Even if the material is new to them, they will not appreciate \nbeing talked to like children\u2014unless, of course, they are children! Make \nsure your tone of voice and the things you say are not condescending.\nU\u00caRepeat the main points of the presentation frequently. Audience members", "source": "shyness_social.pdf"}
{"id": "ddc66e5cc3ba-1", "page_content": "U\u00caRepeat the main points of the presentation frequently. Audience members \nwill not hear everything you say, and if they miss an important point you \nmay lose them for the rest of the presentation unless the important points \nare repeated.\nU\u00caKeep it simple. Don\u2019t try to discuss more than your time allows.\nU\u00caMake sure you are prepared to handle questions. Consider bringing addi -\ntional information (a reference book, notes, and so on) that may be needed \nto answer certain types of questions. No matter how silly a question is, try \nto answer it tactfully and show respect for the person who asked the ques -\ntion (for example, \u201cThat\u2019s an interesting question . . .\u201d). Finally, repeat all \naudience questions before you answer them. Chances are good that people \nin the back of the room will not be able to hear some of the questions the \n\ufb01rst time they are asked.", "source": "shyness_social.pdf"}
{"id": "0a28847fe775-0", "page_content": "Communicating More Effectively\n231U\u00caBe yourself during the talk. Audiences prefer a speaker who is down to earth \nand genuine rather than someone who looks as if he or she is trying too hard \nto be entertaining or to impress the audience.\nAfter the Presentation\nFollowing your presentation, it is helpful to evaluate the quality of your performance, \nbasing your evaluation on whether you followed the suggestions provided in this chapter. \nDon\u2019t base your self-evaluation on whether you were anxious during the presentation or \nwhether your anxiety symptoms showed. The presenter\u2019s anxiety or lack thereof is only \none small aspect of what makes an effective presentation.\nSocial anxiety is associated with the tendency to be an overly harsh critic of one\u2019s \nown performance. Therefore, we suggest that you obtain objective feedback from your \naudience members as well. This can be done informally by asking people what they \nthought of the talk. Or, if appropriate, it can be done more formally by handing out an \nanonymous evaluation form that requires audience members to rate their impressions of \ncertain aspects of the presentation, such as the format of the presentation, the content \n(for example, interest level, relevance, dif\ufb01culty, and so on), the speaker (for example, \npresentation skills, organization, expertise, clarity), use of audiovisual resources, and the \nlocation (for instance, lighting, temperature, seating comfort). In addition, make sure to \ninclude space on the form for audience members to write their impressions (strengths of \nthe presentation, areas for improvement) in their own words.", "source": "shyness_social.pdf"}
{"id": "3f515f425130-0", "page_content": "CHAPTER 11\nMaintaining Your \nImprovements and  \nPlanning for the Future\nThe purpose of this \ufb01nal chapter is to discuss strategies for ensuring that the gains you \nhave made so far are maintained over the coming months and years. Perhaps the most \nimportant suggestion we can offer is that you should continue to use the strategies \ndescribed in the \ufb01rst ten chapters. Continuing to use approaches that were helpful in \ngetting you to where you are now will ensure that you maintain your gains and that your \nanxiety continues to decrease over time.\nTHE END OF TREATMENT\nIn some ways, treatment is never \ufb01nished. Although most people experience improvements \nusing the strategies described in this book, it\u2019s common for people to continue to suffer \nfrom anxiety in some social situations from time to time. Like back pain, depression, and \nhigh blood pressure, anxiety is often a chronic problem that comes and goes, but it can \nalso be controlled. It will be helpful for you to continue to use the methods described in \nthis book to make sure that your anxiety doesn\u2019t worsen. In fact, an important goal of \ncognitive behavioral therapy is to teach people to be their own therapists. If this book \nhas been effective, chances are that your anxiety is much better than it was and you have \nlearned some strategies that you can continue to use as you move forward.", "source": "shyness_social.pdf"}
{"id": "ff3605dfb4a9-0", "page_content": "The Shyness & Social Anxiety Workbook\n234If treatment has been less effective than you would have liked, this is a time to \ufb01gure \nout why. Here are some possible reasons to consider:\nU\u00caInadequate dosage . Typically, we think of dosage in the context of medica -\ntion treatments, and certainly an inadequate dosage of medication (taking \ntoo little medication or taking medication for too short a time) can lead to \na lack of improvement. However, the term \u201cdosage\u201d can also be applied \nto cognitive behavioral strategies. There is evidence that improvement is \ndirectly related to the amount of homework a person completes. So, if your \nexposure practices are too short or too infrequent or you don\u2019t practice \nchallenging your anxiety-provoking thoughts, your anxiety may not have \nimproved as much as you had hoped.\nU\u00caStress . If you were under a lot of stress while working on the strategies in \nthis book, you may have found only limited bene\ufb01t. For example, if you \nwere working very long hours, dealing with family stresses, or coping with \nserious health problems, you may not have been able to devote as much \ntime to this treatment as you might have liked. Our recommendation is to \ntry again once the stress in your life has subsided. Stress can also lead to a \nreturn of fear, an issue to which we will return shortly.\nU\u00caOther psychological problems . In some cases, shyness and social anxiety \nare part of another problem. For example, someone with an eating disor -\nder may have high levels of social anxiety for fear of looking fat in front \nof others. Although the strategies in this book may help in such a case, it \nwould also be important to directly address the eating issues.", "source": "shyness_social.pdf"}
{"id": "ff3605dfb4a9-1", "page_content": "would also be important to directly address the eating issues.\nU\u00caOther life issues . For some people, years of social anxiety can lead to \nvarious long-term problems, including chronic unemployment, extreme \nloneliness, severe depression, or substance-use problems. Without address -\ning these larger issues, the strategies described in this book may not have \nmuch impact on improving your overall quality of life. It will be important \nto \ufb01nd some help and support for these larger issues as well. Chapter 4 \nincludes some recommendations for \ufb01nding a therapist. Professional help \nmay be able to steer you in a direction toward solving these other problems \nin addition to your anxiety.\nWHY FEAR RETURNS AND WHAT YOU  \nCAN DO ABOUT IT\nMost people who receive treatment for social anxiety experience long-lasting improve -\nments in their anxiety, particularly following cognitive and behavioral treatment.", "source": "shyness_social.pdf"}
{"id": "0514b402d92f-0", "page_content": "Maintaining Your Improvements and Planning for the Future\n235Nevertheless, there are a number of different reasons why fear may return for some \nindividuals. If your fear returns, the best thing to do is to resume using the strategies \nthat were most helpful to you the \ufb01rst time you overcame your fear. Social anxiety that \ncomes back sometime after a period of improvement may even be easier to overcome \nthe second time around.\nDiscontinuing the Treatment Strategies Too Early  \nor Too Quickly\nDiscontinuing your cognitive therapy and exposure practices may increase the like -\nlihood of experiencing a return of fear, particularly if you stop using these techniques \nbefore you have completely overcome your anxiety. We recommend that you continue \nto challenge your anxiety-provoking thoughts from time to time for as long as you con -\ntinue to feel anxious. When your fear has decreased signi\ufb01cantly, you can stop using \nthe cognitive diaries. However, you should continue to use the cognitive techniques \ninformally, by silently asking yourself appropriate questions (for example, \u201cIs there some \nother, nonanxious way of interpreting this situation?\u201d).\nIn addition, you should take advantage of opportunities to expose yourself to previ -\nously feared situations even after your fear has been reduced. Sometimes life circum -\nstances (such as being busy at work or school, or recovering from the \ufb02u) make it hard \nto practice exposure on a regular basis. Whenever possible, continue to confront your \nfeared situations from time to time. Occasional exposures should help to prevent your \nfear from returning.\nStopping medication too early may also increase the risk of your anxiety returning. \nAs discussed in chapter 5, relapse following discontinuation from treatment with antide -", "source": "shyness_social.pdf"}
{"id": "0514b402d92f-1", "page_content": "As discussed in chapter 5, relapse following discontinuation from treatment with antide -\npressants is believed to be less likely when treatment has continued for at least a year. So, \nit\u2019s best not to stop medication treatment the moment you start to feel better.\nComing off medication suddenly may also increase the risk of your fear returning. \nDiscontinuation from some antidepressants and from almost all anti-anxiety medications \nis associated with symptoms of withdrawal, which often mimic the symptoms of anxiety. \nThese withdrawal symptoms may prompt some people to resume their old habits of \navoidance and fearful thinking. The best way of preventing withdrawal symptoms fol -\nlowing discontinuation from medication is to reduce the dosage very slowly over time. \nWe strongly recommend that you not reduce or stop your medication without \ufb01rst \n consulting with your doctor.\nLife Stresses\nSometimes, an increase in the stress in your life can lead to a return of anxiety \nand fear. For example, if you experience a stressful life event (increased hours at work,", "source": "shyness_social.pdf"}
{"id": "85e0c40c15c8-0", "page_content": "The Shyness & Social Anxiety Workbook\n236relationship problems, \ufb01nancial dif\ufb01culties, health problems, family tensions, death of a \nclose friend, and the like), you may \ufb01nd that your anxiety in social situations gets worse. \nSometimes, this worsening of anxiety occurs while the stress is ongoing; other times it \nmay occur shortly after the stress has ended.\nThe relationship between stress and increased social anxiety is not surprising. Most \npeople respond to stress in characteristic ways. Some tend to respond physically by \nexperiencing more colds, headaches, increased blood pressure, and other physical ail -\nments. Others may fall into bad habits, such as smoking more, increasing alcohol or caf -\nfeine consumption, eating unhealthy foods, or exercising less. Still others may respond \nemotionally by becoming more anxious, depressed, or irritable. If your natural pattern \nhas been to experience anxiety in social situations, stress may cause some of your old \nresponses to resurface.\nStress tends to increase a person\u2019s arousal level, so breathing becomes heavier, heart \nrate increases, and other symptoms of arousal become more intense. When you\u2019re under \nstress, it doesn\u2019t take much change in your anxiety level for the feeling to become more \nnoticeable than usual. Situations that are normally okay may seem overwhelming when \nyou are experiencing other stresses in your life.\nMost of the time, the increase in social anxiety following stress is temporary; when \nthe stress level improves, the anxiety decreases again. However, if you respond to your \nincreased anxiety by falling back into your old habits of anxious thinking and avoidance \nbehaviors, you may \ufb01nd that the increased social anxiety continues even after the stress \nhas passed. If your anxiety returns following a stressful life event, the best thing to do is", "source": "shyness_social.pdf"}
{"id": "85e0c40c15c8-1", "page_content": "to reread the relevant sections of this book and resume using some of the strategies that \nyou found helpful the \ufb01rst time around.\nEncountering a New and Unexpectedly Dif\ufb01cult Situation\nAlthough you may think you have overcome a particular fear, it is possible that some \nfear remains but that you just haven\u2019t had a chance to encounter a suf\ufb01ciently challeng -\ning situation until now. One of our clients was recently surprised to experience intense \nfear while unexpectedly having to give a toast at his father\u2019s birthday party. He had \nworked very hard to overcome his fear of public speaking at work. After a few months \nof practice, he found he could speak comfortably in meetings, and he even gave long \npresentations to groups of 200 or more with almost no fear. One day, he was asked on \nthe spur of the moment to make a toast at his father\u2019s birthday party to about thirty \nfriends and relatives whom he had known his whole life. This made him very nervous. \nAlthough he had successfully overcome his fear of speaking in formal work situations, \nhe had never had the opportunity to speak in an informal and personal situation like a \nfamily party. For him, giving a toast in front of friends and relatives was actually a new \nsituation that he hadn\u2019t had the chance to practice previously.", "source": "shyness_social.pdf"}
{"id": "e390efb5855a-0", "page_content": "Maintaining Your Improvements and Planning for the Future\n237Experiencing a Trauma in the Feared Situation\nSometimes, experiencing a trauma in a social situation can lead to a return of fear. \nFor example, if your audience during a presentation is particularly cold and unfriendly, \nif you are rejected by someone whom you care about, or if your boss is extremely criti -\ncal of your performance in a meeting, you may \ufb01nd that you\u2019re more anxious the next \ntime you return to the situation. The fact that you had a particular anxiety in the past \nmakes it more likely that it will return if you experience a negative event in a situation \nthat mirrors this old fear.\nIf you experience a negative event in a situation that you previously feared, the best \nthing to do is to return to the situation as soon as possible. If you begin to avoid the \nsituation, your anxiety will be more likely to return. In addition to exposure, try chal -\nlenging your anxious beliefs by considering alternative, nonanxious interpretations of the \nnegative event you experienced.\nPREVENTING YOUR FEAR FROM RETURNING\nAlthough your anxiety is unlikely to return after you have learned to be more comfort -\nable in social and performance situations, there are no guarantees. Nevertheless, there \nare a number of things that you can do to improve your chances of maintaining your \ngains.\nContinue to Use the Cognitive Therapy and Exposure \nStrategies\nAs we\u2019ve discussed, continuing to challenge your anxious thoughts informally and \nto practice exposure from time to time will help you to maintain the improvements that \nyou have made so far. We also recommend that you reread relevant sections from this \nbook occasionally to reinforce what you have learned and to make sure that you haven\u2019t \nforgotten any important principles.", "source": "shyness_social.pdf"}
{"id": "e390efb5855a-1", "page_content": "forgotten any important principles.\nPractice Exposure in a Range of Situations and Contexts\nYour gains are likely to last longer if you practice exposure in a wide variety of situ -\nations and contexts. For example, if you\u2019re fearful of starting conversations, rather than \npracticing starting conversations only at work, we recommend that you practice making \nconversation in other situations as well (for example, at home, at parties, at the bus stop, \nin the elevator, and so on).", "source": "shyness_social.pdf"}
{"id": "cac1e6469f66-0", "page_content": "The Shyness & Social Anxiety Workbook\n238Take Advantage of Opportunities to Overlearn\nOverlearning  involves (1) practicing exposure so many times that it becomes boring \nand second nature, and (2) practicing exposure in situations more dif\ufb01cult than those \nyou encounter in your everyday life. For example, if you are fearful of having your hands \nshake while having a drink, you can practice having them shake so much that you actu -\nally spill some of your drink. (Make sure your glass is \ufb01lled with water and not grape \njuice!) Repeat this practice until it no longer causes anxiety. Or, if you\u2019re fearful of \nmaking a minor mistake when talking to a stranger, you can practice purposely making \nobvious mistakes while speaking to people you don\u2019t know.\nOverlearning is thought to offer protection from experiencing a return of fear. There \nare several advantages of practicing exposure to more dif\ufb01cult situations than those you \nnormally encounter. First, practicing in more challenging situations will automatically \nmake the less challenging situations seem easier. Second, practices in dif\ufb01cult situa -\ntions will further challenge your anxious beliefs. For example, if you learn that nothing \nbad happens even if you purposely make a big mistake during a presentation, you may \nbecome less fearful of accidentally making a small mistake when speaking in public. \nFinally, overlearning provides room for some of your fear to return without causing \nsigni\ufb01cant impairment in your life.\nWHERE TO GO FOR MORE INFORMATION\nFor those who want additional information on social anxiety and related topics, we have \nincluded more useful information at the back of this book. Our list of recommended \nreadings includes books on social anxiety, other anxiety problems, cognitive behavioral \ntherapy, and related topics. This list also includes information on two videos on the", "source": "shyness_social.pdf"}
{"id": "cac1e6469f66-1", "page_content": "therapy, and related topics. This list also includes information on two videos on the \ntreatment of social anxiety. Readings are included both for consumers and profession -\nals. We have also included a resource list of national and international organizations that \nprovide information (including referrals to experienced therapists) to people who suffer \nfrom social anxiety and for professionals who have an interest in this topic. Finally, we \nhave included a list of websites that provide information on social anxiety and effective \ntreatments.\nWe hope that you have found the strategies described in this book helpful. Chances \nare that you will need to continue to use these tools for some time before experiencing \na reduction in social anxiety that has a noticeable impact on your day-to-day life. We \nrecommend that you reread the sections that were particularly useful or inspiring to you. \nMost of all, we wish you good luck as you learn to deal with stressful social situations \nwith a new, well-earned sense of con\ufb01dence.", "source": "shyness_social.pdf"}
{"id": "cb446cf4bb31-0", "page_content": "Recommended Readings\nSHYNESS AND SOCIAL ANXIETY:  \nSELF-HELP BOOKS\nAntony, M.M. 2004. 10 Simple Solutions to Shyness: How to Overcome Shyness, Social Anxiety, and \nFear of Public Speaking . Oakland, CA: New Harbinger.\nHope, D.A., R.G. Heimberg, H.R. Juster, and C.L. Turk. 2000. Managing Social  Anxiety . \nNew York: Oxford.\nRapee, R.M. 1998. Overcoming Shyness and Social Phobia: A Step-by-Step  Guide . Lanham, MD: \nJason Aronson.\nStein, M.B., and J.R. Walker. 2002. Triumph Over Shyness: Conquering Shyness and Social Anxiety . \nNew York: McGraw-Hill.\nSOCIAL AND COMMUNICATION SKILLS:  \nSELF-HELP BOOKS\nDating and Meeting New People\nBerry, D.M. 2005. Romancing the Web: A Therapist\u2019s Guide to the Finer Points of Online Dating . \nManitowoc, WI: Blue Water Publications.\nBurns, D.D. 1985. Intimate Connections . New York: Signet (Penguin Books).", "source": "shyness_social.pdf"}
{"id": "e910bb28a719-0", "page_content": "The Shyness & Social Anxiety Workbook\n240Jacobson, B., and S.J. Gordon. 2004. The Shy Single: A Bold Guide to Dating for the Less-than-Bold \nDater . Emmaus, PA: Rodale.\nKatz, E.M. 2003. I Can\u2019t Believe I\u2019m Buying this Book: A Commonsense Guide to Successful Internet \nDating . Berkeley, CA: 10 Speed Press.\nTessina, T. 1998. The Unof\ufb01cial Guide to Dating Again . New York: Macmillan.\nInterviews\nFry, R. 2007. 101 Great Answers to the Toughest Interview Questions, 5th ed . Clifton Park, NY: \nThomson Delmar Learning.\nMcKay, D.R. 2004. The Everything Practice Interview Book: Be Prepared for Any Question.  Avon, \nMA: Adams Media Corporation.\nStein, M. 2003. Fearless Interviewing: How to Win the Job by Communicating with Con\ufb01dence . New \nYork: McGraw-Hill.\nPublic Speaking and Presentations\nKosslyn, S.M. 2007. Clear and to the Point: 8 Psychological Principles for Compelling PowerPoint \nPresentations . New York: Oxford.\nMacInnis, J.L. 2006. The Elements of Great Public Speaking: How To Be Calm, Con\ufb01dent, and \nCompelling.  Berkeley, CA: 10 Speed Press.\nMcClain, G.R. 2007. Presentations: Proven Techniques for Creating Presentations that Get Results , 2nd \ned. Avon, MA: Adams Media Corporation.", "source": "shyness_social.pdf"}
{"id": "e910bb28a719-1", "page_content": "ed. Avon, MA: Adams Media Corporation.\nMonarth, H., and L. Kase. 2007. The Con\ufb01dent Speaker: Beat Your Nerves and Communicate at Your \nBest in Any Situation . New York: McGraw-Hill.\nMorrisey, G.L., T.L. Sechrest, and W.B. Warman. 1997. Loud and Clear: How to Prepare and \nDeliver Effective Business and Technical Presentations, 4th ed. Reading, MA: Addison-Wesley.\nOther Communication Skills\nBolton, R. 1979. People Skills . New York: Simon & Schuster.\nDavis, M., K. Paleg, and P. Fanning. 2004. The Messages Workbook: Powerful Strategies for Effective \nCommunication at Work & Home . Oakland, CA: New Harbinger.\nFleming, J. 1997. Become Assertive ! Kent, United Kingdom: David Grant Publishing.\nGarner, A. 1997. Conversationally Speaking: Testing New Ways to Increase Your Personal and Social \nEffectiveness, 3rd ed. Los Angeles: Lowell House.", "source": "shyness_social.pdf"}
{"id": "2a367583869d-0", "page_content": "Recommended Readings\n241Honeychurch, C., and A. Watrous. 2003. Talk to Me: Conversation Tips for the Small-Talk \nChallenged . Oakland, CA: New Harbinger.\nMcKay, M., M. Davis, and P. Fanning. 1995. Messages: The Communication Skills Book, 2nd ed. \nOakland, CA: New Harbinger.\nPatterson, R.J. 2000. The Assertiveness Workbook: How to Express Your Ideas and Stand Up for Yourself \nat Work and in Relationships . Oakland, CA: New Harbinger.\nANXIETY DISORDERS AND COGNITIVE \nBEHAVIOR THERAPY: SELF-HELP BOOKS\nAntony, M.M., and R.E. McCabe. 2004. 10 Simple Solutions to Panic: How to Overcome Panic \nAttacks, Calm Physical Symptoms, and Reclaim Your Life . Oakland, CA: New Harbinger.\nAntony, M.M., and R.P. Swinson. 2008. When Perfect Isn\u2019t Good Enough: Strategies for Coping with \nPerfectionism, 2nd ed. Oakland, CA: New Harbinger.\nBieling, P.J., and M.M. Antony. 2003. Ending the Depression Cycle: A Step-by-Step Guide for \nPreventing Relapse. Oakland, CA: New Harbinger.\nBourne, E.J. 2005. The Anxiety and Phobia Workbook, 4th ed . Oakland, CA: New \nHarbinger.\n\u2014\u2014\u2014. 2003. Coping with Anxiety: 10 Simple Ways to Relieve Anxiety, Fear & Worry.  Oakland, \nCA: New Harbinger.", "source": "shyness_social.pdf"}
{"id": "2a367583869d-1", "page_content": "CA: New Harbinger.\nBurns, D.D. 1999. The Feeling Good Handbook, Revised Edition . New York: Plume.\nButler, G., and T. Hope. 2007. Managing Your Mind: The Mental Fitness Guide, 2nd ed. New \nYork: Oxford.\nDavis, M., E.R. Eshelman, and M. McKay. 2008. The Relaxation and Stress Reduction  Workbook, \n6th ed. Oakland, CA: New Harbinger.\nGreenberger, D., and C.A. Padesky. 1995. Mind Over Mood: Change How You Feel by Changing \nthe Way You Think . New York: Guilford.\nGyoerkoe, K.L., and P.S. Wiegartz. 2006. 10 Simple Solutions to Worry: How to Calm Your Mind, \nRelax Your Body, & Reclaim Your Life . Oakland, CA: New Harbinger.\nHyman, B.M., and C. Pedrick. 2005. The OCD Workbook: Your Guide to Breaking  Free from \nObsessive-Compulsive Disorder, 2nd ed. Oakland, CA: New Harbinger.\nMcKay, M., M. Davis, and P. Fanning. 2007. Thoughts and Feelings: Taking Control of Your Moods \nand Your Life, 3rd ed. Oakland, CA: New Harbinger.\nZuercher-White, E. 1997. An End to Panic: Breakthrough Techniques for Overcoming  Panic Disorder, \n2nd ed. Oakland, CA: New Harbinger.", "source": "shyness_social.pdf"}
{"id": "5fe2d1fb9f87-0", "page_content": "The Shyness & Social Anxiety Workbook\n242SOCIAL ANXIETY: BOOKS FOR PROFESSIONALS\nAntony, M.M., and K. Rowa. 2008. Social Anxiety Disorder: Psychological Approaches to Assessment \nand Treatment . G\u00f6ttingen, Germany: Hogrefe.\nBeidel, D.C., and S.M. Turner. 2007. Shy Children, Phobic Adults: Nature and Treatment of Social \nAnxiety Disorder, 2nd ed. Washington, DC: American Psychological Association.\nCrozier, W.R., and L.E. Alden, eds. 2005. The Essential Handbook of Social Anxiety for Clinicians . \nHoboken, NJ: Wiley.\nHeimberg, R.G., and R.E. Becker. 2002. Cognitive-Behavioral Group Therapy for Social Phobia: \nBasic Mechanisms and Clinical Strategies . New York: Guilford.\nHofmann, S.G. 2008. Cognitive-Behavior Therapy of Social Phobia: Evidence-Based and Disorder \nSpeci\ufb01c Treatment Techniques . New York: Routledge.\nHofmann, S.G., and P.M. DiBartolo. 2001. From Social Anxiety to Social Phobia: Multiple \nPerspectives . Needham Heights, MA: Allyn and Bacon.\nHope, D.A., R.G. Heimberg, and C.L. Turk. 2006. Managing Social Anxiety: A Cognitive \nBehavioral Therapy Approach (Therapist Guide) . New York: Oxford.\nKearney, C.A. 2005. Social Anxiety and Social Phobia in Youth: Characteristics, Assessment, and \nPsychological Treatment . New York: Springer.\nStravynski, A. 2007. Fearing Others: The Nature and Treatment of Social Phobia . New York:", "source": "shyness_social.pdf"}
{"id": "5fe2d1fb9f87-1", "page_content": "Cambridge.\nANXIETY DISORDERS AND  \nCOGNITIVE BEHAVIOR THERAPY:  \nBOOKS FOR PROFESSIONALS\nAndrews, G., R. Crino, M. Creamer, C. Hunt, L. Lampe, and A. Page. 2002. The Treatment \nof Anxiety  Disorders: Clinician\u2019s Guide and Patient Manuals, 2nd ed. New York: Cambridge.\nAntony, M.M., and D.H. Barlow, eds. 2002. Handbook of Assessment, Treatment Planning, \nand Outcome Evaluation: Empirically Supported Strategies for Psychological Disorders . New York: \nGuilford.\nAntony, M.M., and M.B. Stein. 2008. Oxford Handbook of Anxiety and Related Disorders . New \nYork: Oxford University Press.\nAntony, M.M., and R.P. Swinson. 2000. Phobic Disorders and Panic in Adults: A Guide to Assessment \nand Treatment . Washington, DC: American Psychological Association.\nAntony, M.M., D.R. Ledley, and R.G. Heimberg, eds. 2005. Improving Outcomes and Preventing \nRelapse in Cognitive Behavioral Therapy. New York: Guilford.", "source": "shyness_social.pdf"}
{"id": "9e58e9ff0838-0", "page_content": "Recommended Readings\n243Antony, M.M., S.M. Orsillo, and L. Roemer, eds. 2001. Practitioner\u2019s Guide to Empirically-Based \nMeasures of Anxiety . New York: Springer.\nBarlow, D.H. 2002. Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic,  2nd \ned. New York: Guilford.\n\u2014\u2014\u2014., ed. 2008. Clinical Handbook of Psychological Disorders, 4th ed. New York: Guilford.\nBeck, A.T., and G. Emery. 1985. Anxiety Disorders and Phobias: A Cognitive Perspective.  New \nYork: Basic Books. \nBeck, J.S. 1995. Cognitive Therapy: Basics and Beyond.  New York: Guilford.\n\u2014\u2014\u2014. 2005. Cognitive Therapy for Challenging Problems: What To Do When the Basics Don\u2019t Work . \nNew York: Guilford.\nBernstein, D.A., T.D. Borkovec, and H. Hazlett-Stevens. 2000. New Directions in Progressive \nRelaxation Training: A Guidebook for Helping Professionals . Westport, CT: Praeger.\nBieling, P.J., R.E. McCabe, and M.M. Antony. 2006. Cognitive Behavioral Therapy in Groups . \nNew York: Guilford.\nEifert, G.H., and J.P. Forsyth. 2005. Acceptance and Commitment Therapy for Anxiety Disorders: \nA Practitioner\u2019s Treatment Guide to Using Mindfulness, Acceptance, and Values-Based Behavior Change \nStrategies . Oakland, CA: New Harbinger.\nKase, L., and D. Ledley. 2007. Anxiety Disorders . Hoboken, NJ: Wiley.", "source": "shyness_social.pdf"}
{"id": "9e58e9ff0838-1", "page_content": "Miller, W.R., and S. Rollnick. 2002. Motivational Interviewing: Preparing People for Change,  2nd \ned. New York: Guilford.\nOrsillo, S.M., and L. Roemer, eds. 2005. Acceptance- and Mindfulness-Based Approaches to Anxiety: \nConceptualization and Treatment . New York: Springer.\nRichard, D.C.S., and D. Lauterbach. 2007. Handbook of Exposure Therapies . New York: \nAcademic Press.\nWright, J.H., M.R. Basco, and M.E. Thase. 2006. Learning Cognitive-Behavior Therapy: An \nIllustrated Guide.  Washington, DC: American Psychiatric Press.\nVIDEO RESOURCES\nAlbano, A.M. 2006. Shyness and Social Phobia . DVD. Washington, DC: American \nPsychological Association.\nRapee, R.M. 1999. I Think They Think \u2026 Overcoming Social Phobia. DVD or VHS. New York: \nGuilford.", "source": "shyness_social.pdf"}
{"id": "8c64fc4a2d1a-0", "page_content": "National and International \nAssociations Providing \nReferrals\nNATIONAL ASSOCIATIONS (UNITED STATES)\nNote that most of these associations offer information for \ufb01nding therapists and other \nresources in the United States and Canada, and several offer information on resources \nin other countries.\nAnxiety Disorders Association of America\n8730 Georgia Ave., Suite 600\nSilver Spring, MD 20910\nUSA\nTel: 1-240-485-1001\nFax: 1-240-485-1035\nWeb: www.adaa.org\nU\u00caAnnual conference (for professionals and consumers)\nU\u00caConsumer memberships and professional memberships\nU\u00caInformation on support groups in the United States, Canada, South Africa, \nMexico, and Australia", "source": "shyness_social.pdf"}
{"id": "b8d621f0bff3-0", "page_content": "The Shyness & Social Anxiety Workbook\n246U\u00caNames of professionals who treat anxiety disorders in the United States, \nCanada, and elsewhere\nAssociation for Behavioral and Cognitive Therapies\n305 Seventh Ave., 16th Floor\nNew York, NY 10001-6008\nUSA\nTel: 1-212-647-1890\nFax: 1-212-647-1865\nWeb: www.abct.org\nU\u00caProfessional memberships only, but offers referrals to consumers\nU\u00caFind a therapist: http://abct.org/members/directory/\ufb01nd  a therapist.cfm\nAcademy of Cognitive Therapy\nOne Belmont Ave., Suite 700\nBala Cynwyd, PA 19004-1610\nUSA\nTel: 1-610-664-1273\nFax: 1-610-664-5137\nE-mail: info@academyofct.org\nWeb: www.academyofct.org\nU\u00caProfessional memberships only, but offers referrals for consumers to certi -\n\ufb01ed cognitive therapists \nAmerican Academy of Cognitive and Behavioral Psychology\nAttn: E. Thomas Dowd, Ph.D., ABPP\nDepartment of Psychology\nKent State University\nKent, OH 44242\nUSA\nTel: 1-330-672-7664\nFax: 1-330-672-3786\nE-mail: edowd@kent.edu\nWeb: www.americanacademyofbehavioralpsychology.org\nU\u00caProfessional memberships only, but offers referrals for consumers to board -\ncerti\ufb01ed psychologists in cognitive behavioral psychology www.american  \nacademyofbehavioralpsychology.org/AABP/FellowDirectory.htm", "source": "shyness_social.pdf"}
{"id": "c27a640830fe-0", "page_content": "National and International Associations Providing Referrals\n247Freedom From Fear\n308 Seaview Ave.\nStaten Island, NY 10305\nUSA\nTel: 1-718-351-1717, ext. 24\nWeb: www.freedomfromfear.org\nE-mail: help@freedomfromfear.org\nU\u00caNational nonpro\ufb01t advocacy organization for people with anxiety disorders \nand depression\nU\u00caNewsletter, blogs, bookstore\nU\u00caInformation on support groups and other resources \nAmerican Psychological Association\n750 First St., N.E.\nWashington, DC 20002-4242\nUSA\nTel: 1-800-374-2721\nWeb: www.apa.org\nU\u00caProfessional memberships only, but offers referrals to consumers\nU\u00caReferral line: 1-800-964-2000\nU\u00caFind a psychologist: http://locator.apa.org/ \nAmerican Psychiatric Association\nAPA Answer Center\n1000 Wilson Blvd., Suite 1825\nArlington, VA 22209\nUSA\nTel: 1-888-35-PSYCH or 1-703-907-7300\nE-mail: apa@psych.org\nWeb: www.psych.org\nU\u00caProfessional memberships only, but offers referrals to consumers", "source": "shyness_social.pdf"}
{"id": "ec24245aaf6a-0", "page_content": "The Shyness & Social Anxiety Workbook\n248INTERNATIONAL ASSOCIATIONS\nAnxiety Disorders Association of Canada\nADAC/ACTA\nP.O. Box 117\nStation Cote St-Luc\nMontreal, QC H4V 2Y3\nCanada\nTel: 1-514-484-0504 or 1-888-223-2252\nFax: 1-514-484-7892\nE-mail: contactus@anxietycanada.ca\nWeb: www.anxietycanada.ca\nU\u00caConsumer memberships and professional memberships\nU\u00caWebsite provides links to other sites with referral options in Canada \nInternational Association for Cognitive Psychotherapy\nWeb: www.cognitivetherapyassociation.org\nU\u00caProfessional memberships only, but offers referrals for consumers to cogni -\ntive therapists: http://www.cognitivetherapyassociation.org/refhome.aspx \nBritish Association for Behavioural and Cognitive Psychotherapies\nVictoria Buildings\n9\u201313 Silver Street\nBury  BL9 0EU\nUnited Kingdom\nTel: 0161 797 4484\nFax: 0161 797 2670\nE-mail: babcp@babcp.com\nWeb: www.babcp.com\nU\u00caProfessional memberships only, but website includes a \u201c\ufb01nd a therapist\u201d \nfeature for consumers. \nAustralian Association for Cognitive and Behaviour Therapy\nWeb: www.aacbt.org\nU\u00caProfessional memberships only, but website includes a list of CBT practitio -\nners for consumers (click on the \u201cstate branches\u201d link at the top, and then \nclick the link near the bottom of the list).", "source": "shyness_social.pdf"}
{"id": "475ef53292bb-0", "page_content": "Internet Resources\nAlthough the information in this section was up to date when this book went to press, \nWeb pages come and go, and addresses for Internet resources change frequently. For \nadditional information on Internet resources, we suggest doing a search using keywords \nsuch as social phobia, social anxiety, and shyness. Note that although we have screened \neach of these sites, we have not reviewed them in detail and cannot take responsibility \nfor the accuracy of the information they contain.\nAnxieties.com\nwww.anxieties.com\nU\u00caA very informative anxiety self-help site run by the Anxiety Disorders \nTreatment Center (and Dr. R. Reid Wilson) in Durham, NC\nAnxiety-Panic.com\nwww.anxiety-panic.com\nU\u00caA search engine for anxiety-related links\nAnxiety Disorders Association of America\nwww.adaa.org\nU\u00caNational association for professionals and consumers with an interest in \nanxiety disorders\nCPA Clinical Practice Guidelines for the Management of Anxiety Disorders\nhttp://ww1.cpa-apc.org:8080/Publications/CJP/supplements/july2006/anxiety  guide  \nlines 2006.pdf", "source": "shyness_social.pdf"}
{"id": "9af9a9abc9ca-0", "page_content": "The Shyness & Social Anxiety Workbook\n250U\u00caDownloadable treatment guidelines published in 2006 by the Canadian \nPsychiatric Association\nInternet Mental Health\nwww.mentalhealth.com\nU\u00caComprehensive website with information on mental health issues\nNIMH Anxiety Disorders Brochure\nhttp://www.nimh.nih.gov/health/publications/anxiety-disorders/summary.shtml\nU\u00caDownloadable brochure on anxiety disorders published in 2007 by the \nNational Institute of Mental Health\nShyness Home Page\nwww.shyness.com\nU\u00caProvides links to information about shyness\nResources for Shy People\nwww.gordoni.com/shy\nU\u00caA list of resources compiled by self-identi\ufb01ed shy person, Gordon Irlam \n(Gordoni)\nSocial Anxiety Support\nwww.socialphobia.org.nz\nU\u00caA New Zealand\u2013based site on social anxiety and related topics\nSocial Phobia/Social Anxiety Association\nwww.socialphobia.org\nU\u00caSite for a nonpro\ufb01t organization focused on social phobia and social \nanxiety\nSocial Phobia World\nwww.socialphobiaworld.com\nU\u00caA place for online forums and chats about social phobia", "source": "shyness_social.pdf"}
{"id": "87b5d0ce9b73-0", "page_content": "References\nAmerican Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders  \n(4th ed., Text Revision). Washington, DC: Author.\nAntony, M.M., D.R. Ledley, A. Liss, and R.P. Swinson. 2006. Responses to symptom \ninduction exercises in panic disorder. Behaviour Research and Therapy  44:85-98.\nAntony, M.M., and K. Rowa. 2008. Social Anxiety Disorder: Psychological Approaches to Assessment \nand Treatment . G\u00f6ttingen, Germany: Hogrefe.\n\u2014\u2014\u2014. 2005. Evidence-based assessment of anxiety disorders. Psychological Assessment 17: \n256-266.\nAntony, M.M., and R.P. Swinson. 2000. Phobic Disorders and Panic in Adults: A Guide to Assessment \nand Treatment . Washington, DC: American Psychological Association.\nAntony, M.M., C.L. Purdon, V. Huta, and R.P. Swinson. 1998. Dimensions of perfec -\ntionism across the anxiety disorders. Behaviour Research and Therapy  36: 1 143-1 154.\nAntony, M.M., K. Rowa, A. Liss, S.R. Swallow, and R.P. Swinson. 2005. Social compari -\nson processes in social phobia. Behavior Therapy 36:65-75.\nBarlow, D.H. 2002. Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic, 2nd \ned. New York: Guilford. \nBeck, A.T. 1963. Thinking and depression: 1. Idiosyncratic content and cognitive distor -\ntions. Archives of General Psychiatry  9:324-333.", "source": "shyness_social.pdf"}
{"id": "87b5d0ce9b73-1", "page_content": "tions. Archives of General Psychiatry  9:324-333.\n\u2014\u2014\u2014. 1964. Thinking and depression: 2. Theory and therapy. Archives of General Psychiatry  \n10:561-571.\n\u2014\u2014\u2014. 1967. Depression: Causes and Treatment . Philadelphia: University of Pennsylvania \nPress.", "source": "shyness_social.pdf"}
{"id": "ae2db24bf71f-0", "page_content": "The Shyness & Social Anxiety Workbook\n252\u2014\u2014\u2014. 1976. Cognitive Therapy of the Emotional Disorders . New York: New American Library.\nBeck, A.T., G. Emery, and R.L. Greenberg. 1985. Anxiety Disorders and Phobias: A Cognitive \nPerspective . New York: Basic Books.\nBezchlibnyk-Butler, K.Z., J.J. Jeffries, and A.S. Virani. 2007. Clinical Handbook of Psychotropic \nDrugs, 17th ed. G\u00f6ttingen, Germany: Hogrefe.\nBieling, P.J., R.E. McCabe, and M.M. Antony. 2006. Cognitive Behavioral Therapy in Groups . \nNew York: Guilford.\nB\u00f6gels, S.M., G.F.V.M. Sijbers, and M. Voncken. 2006. Mindfulness and task concen -\ntration training for social phobia: A pilot study. Journal of Cognitive Psychotherapy 20: \n33-44.\nBolton, R. 1979. People Skills . New York: Simon and Schuster.\nBriggs, S.R. 1988. Shyness: Introversion or neuroticism? Journal of Research  in Personality  22: \n290-307.\nBritton, J.C., and S.L. Rauch. Forthcoming. Neuroanatomy and neuroimaging of anxiety \ndisorders. In Oxford Handbook of Anxiety and Related Disorders, ed. M.M. Antony and M.B. \nStein. New York: Oxford University Press.\nBurns, D.D. 1999. The Feeling Good Handbook, Revised Edition . New York: Plume.", "source": "shyness_social.pdf"}
{"id": "ae2db24bf71f-1", "page_content": "Carducci, B.J. and P.G. Zimbardo. 1995. Are you shy? Psychology Today, November/\nDecember: 34-41, 64, 66, 68, 70, 78, 82. \nChambless, D.L., and E.J. Gracely. 1989. Fear of fear and the anxiety disorders. Cognitive \nTherapy and Research  1 3:9 -20.\nCheek, J.M., and A.K. Watson. 1989. The de\ufb01nition of shyness: Psychological imperial -\nism or construct validity? Journal of Social Behavior and Personality  4:85-95.\nClark, D.M., and A. Wells. 1995. A cognitive model of social phobia. In Social Phobia: \nDiagnosis, Assessment, and Treatment, ed. R.G. Heimberg, M.R. Liebowitz, D.A. Hope, \nand F.R. Schneier, 69-93. New York: Guilford.\nConnor, K.M., and S. Vaishnavi. Forthcoming. Complementary and alternative approaches \nto treating anxiety disorders. In Oxford Handbook of Anxiety and Related Disorders , ed. \nM.M. Antony and M.B. Stein. New York: Oxford University Press.\nCrippa, J.A., A.S. Filho, M.C. Freitas, and A.W. Zuardi. 2007. Duloxetine in the treat -\nment of social anxiety disorder. Journal of Clinical Psychopharmacology 27:310.\nDavidson, J.R., E.B. Foa, J.D. Huppert, F.J. Keefe, M.E. Franklin, J.S. Compton, N.", "source": "shyness_social.pdf"}
{"id": "ae2db24bf71f-2", "page_content": "Zhao, K.M. Connor, T.R. Lynch, and K.M. Gadde. 2004. Fluoxetine, comprehensive \ncognitive behavioral therapy, and placebo in generalized social phobia. Archives of \nGeneral Psychiatry 61:1005-1013.\nDavis, M., K. Paleg, and P. Fanning. 2004. The Messages Workbook: Powerful Strategies for Effective \nCommunication at Work and Home . Oakland, CA: New Harbinger.", "source": "shyness_social.pdf"}
{"id": "05cddb71bd4e-0", "page_content": "References\n253Eifert, G.H., and J.P. Forsyth. 2005. Acceptance and Commitment Therapy for Anxiety Disorders: \nA Practitioner\u2019s Treatment Guide to Using Mindfulness, Acceptance, and Values-Based Behavior Change \nStrategies.  Oakland, CA: New Harbinger. \nEllis, A. 1962. Reason and Emotion in Psychotherapy . Secaucus, NJ: Lyle Stuart.\n\u2014\u2014\u2014 . 1989. The history of cognition in psychotherapy. In Comprehensive Handbook of \nCognitive  Therapy,  ed. A. Freeman, K.M. Simon, L.E. Beutler, and H. Arkowitz, 5-19. \nNew York: Plenum Press.\n\u2014\u2014\u2014. 1993. Changing the name of rational emotive therapy (RET) to rational emotive \nbehavior therapy (REBT). The Behavior Therapist  16:257-258.\nEmmelkamp, P.M.G., and H. Wessels. 1975. Flooding in imagination vs. \ufb02ooding in vivo: \nA comparison with agoraphobics. Behaviour Research and Therapy  1 3:7 -15.\nFry, R. 2007. 101 Great Answers to the Toughest Interview Questions, 5th ed . Clifton Park, NY: \nThomson Delmar Learning.\nFurmark, T., M. Tillfors, I. Marteinsdottir, H. Fischer, A. Pissiota, B. Langstrom, and M. \nFredrikson. 2002. Common changes in cerebral blood \ufb02ow in patients with social \nphobia treated with citalopram or cognitive-behavioral therapy. Archives of General", "source": "shyness_social.pdf"}
{"id": "05cddb71bd4e-1", "page_content": "Psychiatry 59:425-433.\nGarner, A. 1997. Conversationally Speaking: Testing New Ways to Increase Your Personal and Social \nEffectiveness, 3rd ed. Los Angeles: Lowell House.\nGreenberger, D., and C.A. Padesky. 1995. Mind over Mood: A Cognitive Therapy Treatment \nManual for Clients . New York: Guilford.\nHartley, L.R., S. Ungapen, I. Dovie, and D.J. Spencer. 1983. The effect of beta-adrener -\ngic blocking drugs on speakers\u2019 performance and memory. British Journal of Psychiatry  \n142:512-517.\nHayes, S.C., and S. Smith. 2005. Get Out of Your Mind and into Your Life: The New Acceptance \nand Commitment Therapy . Oakland, CA: New Harbinger.\nHedges, D.W., B.L. Brown, D.A. Shwalb, K. Godfrey, and A.M. Larcher. 2007. The \nef\ufb01cacy of selective serotonin reuptake inhibitors in adult social anxiety disorder: A \nmeta-analysis of double-blind, placebo-controlled trials. Journal of Psychopharmacology \n21: 102-111.\nHeimberg, R.G., and R.E. Becker. 2002. Cognitive-Behavioral Group Therapy for Social Phobia: \nBasic Mechanisms and Clinical Strategies . New York: Guilford.\nHenderson, L., and P. Zimbardo. 1999. Shyness. In Encyclopedia of Mental Health,  ed. H.S. \nFriedman. San Diego: Academic Press.\nHirsch, C.R., and D.M. Clark. 2004. Information processing bias in social phobia. Clinical", "source": "shyness_social.pdf"}
{"id": "05cddb71bd4e-2", "page_content": "Psychology Review 24:799-825.\nHoneychurch, C., and A. Watrous. 2003. Talk to Me: Conversation Tips for the Small-Talk \nChallenged . Oakland, CA: New Harbinger.", "source": "shyness_social.pdf"}
{"id": "0500f60bb0b7-0", "page_content": "The Shyness & Social Anxiety Workbook\n254James, I.M., W. Burgoyne, and I.T. Savage. 1983. Effect of pindolol on stress-related \ndisturbances of musical performance: Preliminary communication. Journal of the Royal \nSociety of Medicine  76: 194-196.\nJerremalm, A., J. Johansson, and L.G. \u00d6st. 1980. Applied relaxation as a self-control \ntechnique for social phobia. Scandinavian Journal of Behavioral Therapy  9:35-43.\nKendler, K., L. Karkowski, and C. Prescott. 1999. Fears and phobias: Reliability and \nheritability. Psychological Medicine 29:539\u2013553.\nKendler, K., J. Myers, C. Prescott, and M.C. Neale. 2001. The genetic epidemiology of \nirrational fears and phobias in men. Archives of General Psychiatry 58:257\u2013265.\nKessler, R.C., P. Berglund, O. Demler, R. Jin, and E.E. Walters. 2005. Lifetime prevalence \nand age-of-onset distributions of DSM-IV disorders in the National Comorbidity \nSurvey Replication. Archives of General Psychiatry 62:593-602.\nKessler, R.C., A.M. Ruscio, K. Shear, and H.U. Wittchen. Forthcoming. Epidemiology of \nanxiety disorders. In Oxford Handbook of Anxiety and Related Disorders, ed. M.M. Antony \nand M.B. Stein. New York: Oxford University Press.\nKnox, D., V. Daniels, L. Sturdivant, and M.E. Zusman. 2001. College student use of the", "source": "shyness_social.pdf"}
{"id": "0500f60bb0b7-1", "page_content": "internet for mate selection. College Student Journal 35:158-161.\nKobak, K.A., L.V. Taylor, G. Warner, and R. Futterer. 2005. St. John\u2019s wort versus \nplacebo in social phobia: Results from a placebo-controlled pilot study. Journal of \nClinical Psychopharmacology 25:51\u201358.\nLaumann, E.O., J.H. Gagnon, R.T. Michael, and S. Michaels. 1994. The Social Organization \nof Sexuality: Sexual Practices in the United States . Chicago: University of Chicago Press.\nLiebowitz, M.R., R.G. Heimberg, F.R. Schneier, D.A. Hope, S. Davies, C.S. Holt, D. \nGoetz, H.R. Juster, S.H. Lin, M.A. Bruch, R.D. Marshall, and D.F. Klein. 1999. \nCognitive-behavioral group therapy versus phenelzine in social phobia: Long term \noutcome. Depression and Anxiety  10:89-98.\nLipsitz, J.D., A.J. Fyer, J.C. Markowitz, and S. Cherry. 1999. An open trial of interper -\nsonal psychotherapy for social phobia. American Journal of Psychiatry 156:1814-1816.\nLochner, C., S. Hemmings, S. Seedat, C. Kinnear, R. Schoeman, K. Annerbrink, M. \nOlsson, E. Eriksson, J. Moolman-Smook, C. Allgulander, and D.J. Stein. 2007. \nGenetics and personality traits in patients with social anxiety disorder: A case-", "source": "shyness_social.pdf"}
{"id": "0500f60bb0b7-2", "page_content": "Genetics and personality traits in patients with social anxiety disorder: A case-\n control study in South Africa. European Neuropsychopharmacology  1 7 :321-327 .\nMathew, S.J., and S. Ho. 2006. Etiology and neurobiology of social anxiety disorder. \nJournal of Clinical Psychiatry 67(suppl. 12):9\u201313.\nMcCabe, R.E., and M.M. Antony. Forthcoming. Anxiety disorders: Social and speci\ufb01c \nphobias. In Psychiatry, 3rd ed, ed. A. Tasman, J. Kay, J.A. Lieberman, M.B. First, and \nM. Maj. Chichester, UK: John Wiley and Sons.\nMcCabe, R.E., M.M. Antony, L.J. Summerfeldt, A. Liss, and R.P. Swinson. 2003. A \npreliminary examination of the relationship between anxiety disorders in adults and", "source": "shyness_social.pdf"}
{"id": "edd604b8b9d7-0", "page_content": "References\n255self-reported history of teasing or bullying experiences. Cognitive Behaviour Therapy 32: \n187-193.\nMcKay, M., M. Davis, and P. Fanning. 1995. Messages: The Communication Skills  Book, 2nd ed. \nOakland, CA: New Harbinger.\nMeichenbaum, D.H. 1977. Cognitive Behavior Modi\ufb01cation: An Integrative Approach . New York: \nPlenum Press.\nMiller, W.R., and S. Rollnick. 2002. Motivational Interviewing: Preparing People to Change, 2nd \ned. New York: Guilford.\nMoalem, S., and P. Prince. 2007. Survival of the Sickest: A Medical Maverick Discovers Why We \nNeed Disease . New York: Harper Collins.\nMonarth, H., and L. Kase. 2007. The Con\ufb01dent Speaker: Beat Your Nerves and Communicate at Your \nBest in Any Situation . New York: McGraw-Hill.\nMoore, E., A.E. Braddock, and J.S. Abramowitz. 2007. Ef\ufb01cacy of bibliotherapy for \nsocial anxiety disorder . Paper presented at the meeting of the Anxiety Disorders \nAssociation of America, St. Louis, MO.\nMuehlbacher, M., M.K. Nickel, C. Nickel, C. Kettler, C. Lahmann, F. Pedrosa Gil, P.K. \nLeibereich, N. Rother, E. Bachler, R. Fartacek, P. Kaplan, K. Tritt, F. Mitterlehner,", "source": "shyness_social.pdf"}
{"id": "edd604b8b9d7-1", "page_content": "J. Anvar, M.K. Rother, T.H. Loew, and C. Egger. 2005. Mirtazepine treatment of \nsocial phobia in women: A randomized, double-blind, placebo-controlled study. \nJournal of Clinical Psychopharmacology 25:580-583.\nMulkens, S., P.J. de Jong, A. Dobbelaar, and S.M. B\u00f6gels. 1999. Fear of blushing: Fearful \npreoccupation irrespective of facial coloration. Behaviour Research and Therapy  37: \n1119-1128.\nNesse, R.M., and G.C. Williams. 1994. Why We Get Sick: The New Science of  Darwinian \nMedicine . New York: Vintage Books.\nOrsillo, S.M., and L. Roemer, eds. 2005. Acceptance- and Mindfulness-Based Approaches to Anxiety: \nConceptualization and Treatment . New York: Springer.\nOsberg, J.W. 1981. The effectiveness of applied relaxation in the treatment of speech \nanxiety. Behavior Therapy  12:723-729.\nOssman, W.A., K.G. Wilson, R.D. Storaasli, and J.W. McNeill. 2006. A preliminary inves -\ntigation of the use of acceptance and commitment therapy in a group treatment for \nsocial phobia. International Journal of Psychology and Psychological Therapy 6:397-416.\nPhan, K.L., D.A. Fitzgerald, P.J. Nathan, and M.E. Tancer. 2006. Association between \namygdala hyperactivity to harsh faces and severity of social anxiety in generalized \nsocial phobia. Biological Psychiatry 59:424-429.", "source": "shyness_social.pdf"}
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{"id": "20fe4da469db-0", "page_content": "References\n257Straube, T., I.T. Kolassa, M. Glauer, H.J. Mentzel, and W.H. Miltner. 2004. Effect of \ntask conditions on brain responses to threatening faces in social phobics: An event-\nrelated functional magnetic resonance imaging study. Biological Psychiatry  56:921-930.\nSu\u00e1rez, L., S. Bennett, C. Goldstein, and D.H. Barlow. Forthcoming. Understanding \nanxiety disorders from a \u201ctriple vulnerability\u201d framework. In Oxford Handbook of \nAnxiety and Related Disorders,  ed. M.M. Antony and M.B. Stein. New York: Oxford \nUniversity Press.\nSue, D.W. 1990. Culture-speci\ufb01c strategies in counseling: A conceptual framework. \nProfessional Psychology: Research and Practice  21:424-433.\nSwinson, R.P., M.M. Antony, P. Bleau, P. Chokka, M. Craven, A. Fallu, K. Kjernisted, R. \nLanius, K. Manassis, D. McIntosh, J. Plamondon, K. Rabheru, M. Van Ameringen, \nand J.R. Walker. 2006. Clinical practice guidelines: Management of anxiety disor -\nders. Canadian Journal of Psychiatry  51(suppl. 2):1S \u2013 92S.\nTaylor, S., W.J. Koch, and R.J. McNally. 1992. How does anxiety sensitivity vary across \nthe anxiety disorders? Journal of Anxiety Disorders  6:249-259.\nTessina, T. 1998. The Unof\ufb01cial Guide to Dating Again . New York: Macmillan.", "source": "shyness_social.pdf"}
{"id": "20fe4da469db-1", "page_content": "Turk, C.L., R.G. Heimberg, S.M. Orsillo, C.S. Holt, A. Gitow, L.L. Street, F.R. Schneier, \nand M.R. Liebowitz. 1998. An investigation of gender differences in social phobia. \nJournal of Anxiety Disorders  12:209-223.\nVan Ameringen, M., C. Mancini, and B. Patterson. Forthcoming. Pharmacotherapy for \nsocial anxiety disorder and speci\ufb01c phobia. In Oxford Handbook of Anxiety and Related \nDisorders,  ed. M.M. Antony and M.B. Stein. New York: Oxford University Press.\nVan Veen, J.F., I.M. Van Vliet, and H.G. Westenberg. 2002. Mirtazapine in social anxiety \ndisorder: A pilot study. International Clinical Psychopharmacology  1 7 :3 15-3 1 7 .\nWeissman, M.M., J.C. Markowitz, and G.L. Klerman. 2007. Clinician\u2019s Quick Guide to \nInterpersonal Psychotherapy . New York: Oxford University Press.\nWilliams, M., J. Teasdale, Z. Segal, and J. Kabat-Zinn. 2007. The Mindful Way Through \nDepression: Freeing Yourself from Chronic Unhappiness . New York: Guilford.\nZimbardo, P.G., P.A. Pilkonis, and R.M. Norwood. 1975. The social disease of shyness. \nPsychology Today  8:68-72.", "source": "shyness_social.pdf"}
{"id": "75fffb5b285a-0", "page_content": "Martin M. Antony, Ph.D.,  is professor of psychology at Ryerson University in Toronto, \nON, and director of research at the Anxiety Treatment and Research Centre at St. \nJoseph\u2019s Healthcare in Hamilton, ON. He is also president-elect of the Canadian \nPsychological Association. He has published twenty-four books and more than 100 sci -\nenti\ufb01c papers and book chapters in the areas of cognitive behavior therapy and anxiety \ndisorders. He has received early career awards from the Society of Clinical Psychology \n(American Psychological Association), the Canadian Psychological Association, and the \nAnxiety Disorders Association of America, and is a fellow of the American and Canadian \nPsychological Associations. He is past president of the Anxiety Disorders Special \nInterest Group of the Association for Behavioral and Cognitive Therapies (ABCT) and \nhas been program chair for the ABCT annual convention. He is actively involved in \nclinical research in the area of anxiety disorders, teaching, and education, and maintains \na clinical practice. Visit him online at www.martinantony.com.\nRichard P. Swinson, MD, is professor emeritus and past chair of the Department of \nPsychiatry and Behavioural Neurosciences at McMaster University in Hamilton, ON, \nCanada.  He is also medical director of the Anxiety Treatment and Research Centre \nand past psychiatrist-in-chief at Joseph\u2019s Healthcare, also in Hamilton. He is a fellow \nof the Royal College of Physicians and Surgeons of Canada, the American Psychiatric \nAssociation, and the Royal College of Psychiatrists UK. He was awarded an inaugu -\nral fellowship of the Canadian Psychiatric Association in 2006. His research interests \nlie in the theory, assessment and treatment of anxiety disorders, particularly obsessive-\ncompulsive disorder and social anxiety disorder.  He has published more than 180 peer-", "source": "shyness_social.pdf"}
{"id": "75fffb5b285a-1", "page_content": "compulsive disorder and social anxiety disorder.  He has published more than 180 peer-\nreviewed papers, thirty book chapters, and eight books. Dr. Swinson has held numerous \nresearch grants since 1966 and has been an invited speaker at many conferences around \nthe world on anxiety disorders and substance use disorders. He also chaired the steer -\ning committee for the Canadian Anxiety Treatment Guidelines Initiative, leading to the \npublication of Canadian Clinical Practice Guidelines for the Management of Anxiety \nDisorders in 2006.", "source": "shyness_social.pdf"}
{"id": "95eb5eef6086-0", "page_content": "Hogrefe & Huber Publishers \u00b7 30 Amberwood Parkway \u00b7 Ashland, OH 44805\nTel: (800) 228- 3749 \u00b7 Fax: (419) 281- 6883 \u00b7 E-Mail: custser v@hogrefe.comMartin M. Antony, Karen Rowa\nSocial Anxiety Disorder\nIn the series: Advances in Psychotherapy \n\u2013  Evidence-Based Practice\n2008, X + 102 pages, softcover, US $ 24.95 (Series Standing Order: US $ 19.95)\nISBN: 978-0-88937-311-2\nRecent studies suggest that approximately 7% of Americans suffer from \nsocial anxiety disorder. In addition to the high percentage of people with \nsymptoms meeting criteria for this disorder, many other individuals \nexperience social anxiety or shyness to a lesser, but still impairing degree. \nPractitioners are likely to encounter patients displaying some degree of \nsocial anxiety, no matter what specialty service or setting they occupy. \nOver the past 20 years, effective tools have been developed to identify \nand treat social anxiety. This book provides straightforward, accessible \nassessment and treatment information for clinicians and students on \nthe diagnosis, identi\ufb01  cation, conceptualization, and treatment of social \nanxiety and social phobia.\nOrder online!\nwww.hogrefe.com\n\u201cThis book \ufb01  lls an important gap in the literature \u2013 \ufb01  lled with clinical examples \nand advice, its straightforward presentation will allow clinicians with various \nlevels of expertise to implement these ef\ufb01  cacious interventions. [The authors] \nprovide not only a valuable tool for their colleagues, but also hope for the \nmillions who suffer from SAD. \u201d", "source": "shyness_social.pdf"}
{"id": "95eb5eef6086-1", "page_content": "millions who suffer from SAD. \u201d\nDeborah C. Beidel, PhD, Professor and Director of Clinical Training, \nUniversity of Central Florida, Orlando, FL\u201c[The authors] are to be congratulated for putting together a concise, practical, \neminently readable primer on diagnosis and treatment of SAD. Yes, the advice is \nevidence-based, but it is also grounded in years of experience treating patients\u2026 \nIt is required reading for any therapist seeking to broaden or sharpen their \nexpertise in this area. \u201d\nMurray B. Stein, MD, MPH, Professor, Department of  Psychiatry, and Director, \nAnxiety & Traumatic Stress  Disorders Program, University of California San Diego, CA\nCall toll free 800 228-3749  to order or visit www.hogrefe.com  for more detailsAlso by this Author:\nTable of Contents\n1 Description: \u0001(0;7489692B\u0001G\u0001\u001a0D \u000184=498\u0001G\u0001\u001b:4/0749692B\u0001G\u0001\u00199>;<0\u0001,8/\u0001%;9289<4<\u0001G\u0001\u001a4110;08=4,6\u0001\u001a4,289<4<\u0001G\u0001\u0019979;-4/4=B\u0001G\u0001\u001a4,289<=4.\u0001\nProcedures and Documentation\n2 Psychological Approaches to Understanding Social Anxiety Disorder: (30\u0001\u00199284=4?0\u0001\"9/06\u000191\u0001\u00196,;5\u0001,8/\u0001*066<\u0001G\u0001(30\u0001\u00199284=4?0\u0001\u001803,?49;,6\u0001\"9/06\u0001", "source": "shyness_social.pdf"}
{"id": "95eb5eef6086-2", "page_content": "91\u0001&,:00\u0001,8/\u0001\u001e047-0;2\u0001G\u0001#02,=4?0\u0001!0,;8482\u0001\u001bA:0;408.0<\u0001,8/\u0001'9.4,6\u0001\u00178A40=B\u0001G\u0001(07:0;,708=,6\u0001\u0018,<0<\u000191\u0001'\u0017\u001a\u0001G\u0001\u001f7:64.,=498<\u000119;\u0001(;0,=7 ent\n3 Diagnosis and Treatment Indications:  0B\u0001\u001c0,=>;0<\u0001=9\u0001-0\u0001\u0017<<0<<0/\u0001G\u0001$?0;?40@\u000191\u0001\u001b110. =4?0\u0001(;0,=708=\u0001'=;,=0240<\u0001G\u0001\u001c,.=9;<\u0001(3,=\u0001\u001f8E \u0001>08.0\u0001\nTreatment Decisions\n4 Treatment: \"0=39/<\u000191\u0001\u0019\u0018(\u0001G\u0001\"0.3,84<7<\u000191\u0001\u0017.=498\u0001G\u0001\u001b1D \u0001.,.B\u0001\t\u0001\u001997-48,=498\u0001(;0,=708=<\u0001G\u0001$?0;.97482\u0001\u0018,;;40;<\u0001=9\u0001(;0,=708=\u0001G\u0001\u0017/,:=482\u0001\n(;0,=708=\u000119;\u0001\u001a4110;08=\u0001\u001720\u0001\u001d;9>:<\u0001G\u0001\u0017/,:=482\u0001(;0,=708=\u000119;\u0001\u001a4110;08=\u0001\u0019>6=>;0<\n5 Case Vignettes     G\u0001\u0001\u0001\u0001\u00016     Further Reading     G\u0001\u0001\u0001\u0001 7     References     G\u0001\u0001\u0001\u0001 8     Appendix: Tools and Resources", "source": "shyness_social.pdf"}
{"id": "6988f3ad176b-0", "page_content": "more books  from new harbinger publications, inc.\nTALK TO ME  \nConversation Tips for the  \nSmall-Talk Challenged \nUS $12.95 / ISBN:  978-1572243316MESSAGES, \nSECOND EDITION \nThe Communication Skills Book \nUS $16.95  / ISBN:  978-1572240223\nTo order, call toll free 1-800-748-6273  or visit our online \nbookstore at  www.newharbinger.com \n(VISA, MC, AMEX  /  prices subject to change without notice)new harbinger publications, inc.available from\nand fine booksellers everywhere\n10 SIMPLE S OLU TIONS  \nTO SHYNESS \nHow to Overcome Shyness, \nSocial Anxiety &  \nFear of Public Speaking \nUS $12.95  / ISBN:  978-1572243484\nTHE ANXIE TY & PHOBIA  \nWORKBOOK, FOUR TH EDI TION \nUS $21.95 / ISBN:  978-1572244139ANXIOUS 9/u002D.j5  \nHow to Heat Worry, Stop  \nSecond-Guessing Yourself &  \nWork with Con\ufb01dence  \nUS $14.95 / ISBN:  978-1572244641", "source": "shyness_social.pdf"}
{"id": "4b317198f4fd-0", "page_content": "MARTIN M. ANTONY , PH.D.\nRICHARD P . SWINSON, MDPROVEN, STEP-BY-STEP TECHNIQUES \nFOR OVERCOMING YOUR FEARA NEW HARBINGER SELF-HELP WORKBOOKTheShyness & Social Anxiety Workbook\nSECOND EDITIONIs Fear of Social Situations Keeping You from Living the Life You Want?\nThere\u2019s nothing wrong with being shy. But if social anxiety keeps you from forming relationships with others, \nadvancing in your education or your career, or carrying on with everyday activities, you may need to confront \nyour fears to live an enjoyable, satisfying life. This new edition of The Shyness and Social Anxiety Workbook  offers a \ncomprehensive program to help you do just that.\nAs you complete the activities in this workbook, you\u2019ll learn to:\nU\u00ca\u00ca\u0013\u0088\u0098`\u00ca\u00de\u009c\u00d5\u00c0\u00ca\u00c3\u00cc\u00c0i\u0098}\u00cc\u0085\u00c3\u00ca>\u0098`\u00ca\u00dci>\u008e\u0098i\u00c3\u00c3i\u00c3\u00ca\u00dc\u0088\u00cc\u0085\u00ca>\u00ca\u00c3i\u008fv\u0087i\u00db>\u008f\u00d5>\u00cc\u0088\u009c\u0098\u00ca\u00caU\u00ca\u00ca\r\u00dd\u00ab\u008f\u009c\u00c0i\u00ca>\u0098`\u00cai\u00dd>\u0093\u0088\u0098i\u00ca\u00de\u009c\u00d5\u00c0\u00cavi>\u00c0\u00c3\u00ca\nU\u00ca\u00ca\n\u00c0i>\u00cci\u00ca>\u00ca\u00abi\u00c0\u00c3\u009c\u0098>\u008f\u0088\u00e2i`\u00ca\u00ab\u008f>\u0098\u00cav\u009c\u00c0\u00caV\u0085>\u0098}i\u00ca", "source": "shyness_social.pdf"}
{"id": "4b317198f4fd-1", "page_content": "U\u00ca\u00ca*\u00d5\u00cc\u00ca\u00de\u009c\u00d5\u00c0\u00ca\u00ab\u008f>\u0098\u00ca\u0088\u0098\u00cc\u009c\u00ca>V\u00cc\u0088\u009c\u0098\u00ca\u00cc\u0085\u00c0\u009c\u00d5}\u0085\u00ca}i\u0098\u00cc\u008fi\u00ca>\u0098`\u00ca}\u00c0>`\u00d5>\u008f\u00cai\u00dd\u00ab\u009c\u00c3\u00d5\u00c0i\u00ca\u00cc\u009c\u00ca\u00c3\u009cV\u0088>\u008f\u00ca\u00c3\u0088\u00cc\u00d5>\u00cc\u0088\u009c\u0098\u00c3\nInformation about therapy, medications, and other resources is also included. After completing this program, \nyou\u2019ll be well-equipped to make connections with the people around you. Soon, you\u2019ll be on your way to enjoying \nall the bene\ufb01ts of being actively involved in the social world.\n\u201cAnyone who experiences signi\ufb01cant anxiety when performing or when interacting with other people \nshould read this book!\u201d  \u2014AARON T. BECK, MD, university professor of psychiatry at the University of Pennsylvania\n\u201cBased on the tried and true methods of cognitive-behavioral therapy\u2026 the techniques described \nin this book will help you feel better when you are with other people or the center of attention.\u201d  \n\u2014RICHARD HEIMBERG, PH.D., director of the Adult Anxiety Clinic of T emple University, Philadelphia\n\u201cThis volume, written by a team composed of a psychologist and a psychiatrist, is an outstanding \nworkbook for any individual suffering from social anxiety or shyness.\u201d  \u2014JACQUELINE B. PERSONS, \nPH.D., clinical professor in the department of psychology at the University of California, Berkeley", "source": "shyness_social.pdf"}
{"id": "4b317198f4fd-2", "page_content": "PH.D., clinical professor in the department of psychology at the University of California, Berkeley\n\u201cThis is a must-read for persons suffering with social anxiety.\u201d  \u2014MICHELLE G. CRASKE, PH.D., professor \nof psychology at the University of California, Los Angeles\nMARTIN M. ANTONY , PH.D., is professor of psychology at Ryerson University in T oronto, director of research at the \nAnxiety T reatment and Research Centre at St. Joseph\u2019s Healthcare in Hamilton, ON, and president-elect of the Canadian \nPsychological Association. He lives in T oronto, ON, Canada.\nRICHARD P . SWINSON, MD, is professor emeritus and past chair of the \nDepartment of Psychiatry and Behavioural Neurosciences at McMaster Uni-\nversity in Hamilton, ON, Canada. He is also medical director of the Anxiety \nT reatment and Research Centre at Joseph\u2019s Healthcare, also in Hamilton. \nSwinson lives in T oronto, ON, Canada.The Shyness &\u00ca-\u009cV\u0088>\u008f\u00ca\u0001\u0098\u00dd\u0088i\u00cc\u00de\u00ca Workbook                                                                                                                                                                       SELF -HELP \nnewharbinger publications, inc.\nwww.new harbinger .com\nANTONY \nSWINSON-\r\n\" \f  \n\r\f\u0016/\u0016\"", "source": "shyness_social.pdf"}