Reducing Shame through Group Therapy for Social Anxiety

Social anxiety (SAD) can be a debilitating condition. The symptoms of SAD include fear, shame, guilt, depression, and avoidance of situations that trigger any of those emotions. People with SAD often have difficulty in social situations and are less than adept at navigating interpersonal relationships. They are fearful of what others will think of them and whether they will be accepted or not. Fear of rejection and criticism are common traits among people with SAD. Therapeutic efforts can decrease these emotional barriers for many people with SAD. But, until recently, specific symptoms of SAD have not been measured as an outcome to treatment. To find out how well cognitive behavioral therapy (CBT) works at reducing some of the most limiting symptoms of SAD, Erik Hedman of the Department of Clinical Neuroscience at Karolinska Institute in Stockholm, Sweden recently conducted a study measuring levels of shame, depression, and guilt before and after CBT.

Hedman assessed 67 participants with SAD and compared them to 94 control participants. He evaluated shame as a self-directed internal appraisal of worth, guilt as an appraisal of how one felt about one’s actions, and depression as general negative affect and opinion of oneself. Hedman found that the participants with SAD had higher levels of depression and shame than the controls prior to CBT. However, guilt was not directly related to SAD in this sample. After the intervention, participants saw significant reductions in symptoms of shame, and to a lesser extent, depression. Hedman noticed that levels of internal shame, although not the focus of CBT per se, decreased the most. This suggests that CBT is effective at helping individuals transform their distorted beliefs about themselves thereby improving self-worth.

Another interesting finding was that the largest gains were made in the participants who took part in group CBT. Hedman believes that perhaps the realization that their condition is not an isolated one and that others also harbor similar social anxieties helps people with SAD gain the courage to embrace new beliefs. Although this is speculation, further research could validate this theory. Hedman added, “A clinical implication of these finding could be that group CBT is especially suitable for persons with SAD who have high levels of internal shame.”

Hedman, E., Ström, P., Stünkel, A., Mörtberg, E. (2013). Shame and guilt in social anxiety disorder: Effects of cognitive behavior therapy and association with social anxiety and depressive symptoms. PLoS ONE 8(4): e61713. doi:10.1371/journal.pone.0061713

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  • Michel S

    May 3rd, 2013 at 10:52 PM

    I had social anxiety until I was 12 years old.I know how it feels.I may not have met the criteria to be labelled as socially anxious but I knew I had a problem.How did I get over it?Thanks to my uncle who instilled in me the belief that we don’t really need others’ approval to feel good about ourselves.

    No matter what others think or believe it is your views that matter and nothing else.So that thought and belief has stuck even until today and it helped to a great extent with my social anxiety.For me the very confidence I gained about myself is what got me out.I just hope these people are able to come out of this fear that is largely self created and only amplified or feed to by external agents or factors.

  • garrison

    May 4th, 2013 at 4:51 AM

    I have read a lot about group therapy, and I see here another piece that shows that this can help people living with some form or another of mental illness overcome their shame about it and receive therapy that is very rewarding. I kind of feel though that I am on the opposite end of the spectrum, that sharing my thoughts and feelings in front of strangers will make me more embarassed. I think that I would be far more likely to be successful with a therapist with whom I can meet with one on one and get to know instead of feeling like I am divulging all to people who don’t know me and might be very judgemental about the information that they hear.

  • Grace

    May 4th, 2013 at 12:20 PM

    My first inclination would more than likely to have felt like garrison, that I would not like group therapy.

    But it is kind of nice to sit down with a group of people who have no preconceived notions about you and yet they are able to offer so much back to you because they know exactly the feelings that you are having and understand what you could be going through.

  • East Star

    May 6th, 2013 at 12:09 AM

    We’re social beings by nature. hard to think some people have trouble with social situations .maybe they developed it in their childhood? or can this be an inborn thing too? in any case facing the problem and overcoming it is the est way I think. conquering your fears could prove helpful here.

  • Riley

    May 6th, 2013 at 3:56 AM

    The hardest thing to realize with group dynamics is that these are not peope who are here to judeg you.
    I honestly think that most people who go through working with a group really want the others they work with to succeed.
    That gives the whole group hope that change can happen, that life does not have to be just doom and gloom.

  • L portman

    May 6th, 2013 at 11:23 PM

    think I have a few of these real world issues actually but I do have concerns.I can get along well with people i know and friends but sometimes that is hard for strangers and new people that does make me nervous.I want to be a confident person who can meet new people and fearless share things with them but I guess you either have it or you don’t :(

  • John

    June 25th, 2013 at 8:07 AM

    I believe the need to be social is a safety mechanism that dates back to thousands of years ago where groups, villages and clans were formed to protect one another from the wilderness and other warring factions and to be cast out was a death sentence, so being social accepted was a matter of life or death. Today we carry those same social accepted survival techniques and when faced with rejection some are filled with anxiety and traumitized.

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