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.”
Reference:
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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