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Intervention Targets for Social Anxiety
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What's Another Way of Looking at It?
Next, let's look at the question,
"What's another way of looking at it?"
The interventions we'll discuss
are ... Generating Alternative Interpretations, Dysfunctional Thought Records,
Decentering, Enlarging Perspective, and Reattribution.
♦ 1. Generating Alternative Interpretations
As you know, your
anxious child or adult client's closed and limited view of reality excludes more
neutral and more realistic interpretations. A major therapeutic aim is to teach
the client to consider possibilities other than his or her dire predictions. Although
the therapist uses different methods to achieve this aim, the standard procedure
is to have the client write down his anxiety-producing thoughts, then search for
alternative interpretations (the "two-column" technique). I model this
first during the session, using a clipboard.
♦ 2. Interpretations
Mike's anxiety is centered on his fear of being fired. When his supervisor was
aloof, he would think, "He's avoiding me. He's going to fire me. That's why
he won't smile at me."
Alternative explanations that he was able to generate
1. "The supervisor does not smile at any of the workers.
It's not just me."
2. "There is a real status difference between
3. "He could dislike me regardless of what he thinks
of my competence."
4. "Even if he does think I'm incompetent, the
other supervisors there know I'm not."
The client was eventually
able to lower his anxiety by repeatedly considering alternative interpretations.
He came to see that the alternatives were nearly always more accurate, and certainly
more functional, than his original appraisal of the situation.
the ideal situation is for the client to generate believable viewpoints, he or
she often has difficulty doing so because their focus is on the threat. If you
excel at divergent thinking, you can be most helpful by constructing a large list
of alternatives and the client is likely to find one or two useful ones. I make
this technique effective by repeatedly asking, "Which alternative way of
thinking is the most helpful to you?," and, "What is the resulting behavior
♦ 3. Dysfunctional Thought Records
A primary strategy of a dysfunctional thought record is to teach the client to
recognize his automatic thoughts outside of the session and to strive for a more
balanced alternative view.
Provide your client with a notebook. Have them write:
1. The situation leading to anxiety;
2. The emotion felt and degree of emotion; and
3. The automatic
thought and degree of belief in the thought.
This process helps your client learn
how to monitor changes in level of anxiety, to recognize automatic thoughts, and
to understand their relationship to anxiety. When he has mastered these skills,
the client is ready to begin providing the "rational response" and outcome
Simply giving a notebook to a client, I have found, makes it
more likely that he will do his written homework. However, often the client may
try writing his thinking and concentrate only on the threat side. The therapist
needs to stress the importance of dividing the written homework into at least
two parts: anxiety-producing thoughts and corrections of their exaggerations.
I, of course, have found, like you, that the client may not want to write
down his thoughts because he fears doing so will make him more anxious or because
they will look "silly" or "childish." The reasons the client
has for avoiding his homework often are the same ones that maintain his anxiety.
When the client fails to bring in written homework, I probe the thoughts behind
his or her avoidance. Linda avoided doing her homework because she believed she
"would screw it up!" Eliciting avoidance thinking helped identify Linda's
underlying assumptions. ("I have to show everyone a flawless image of myself.")
Bob believed that I was incompetent. We ended up exploring Bob's general distrust
of others. His assumption was, "I can't trust anyone."
♦ 4. Decentering
Another technique regarding, "What's Another Way Of Looking At It?"
is called decentering. As you know, decentering is the process of having your
client challenge the basic belief that he or she is the focal point of all events.
Many clients with social anxiety report thinking that everyone is watching them
or that others are actually aware of their tensions or shyness. Rose believed
that others could read her mind.
Feeling the Focus of Attention
Let's review the variety of strategies you can
use to help a client see that his or her social world does not revolve around
them. You work out with your client to established concrete criteria to determine
when he or she feels the focus of attention and what behavior or attributes are
being attended to by others.
Since the client is required to adopt the
perspective of another person, participation in this task requires a shift in
focus on the part of the client. Jeff, age 25, was severely handicapped and self-conscious
and so preoccupied with his own internal reactions that he noticed little about
other's reactions to him; paradoxically, he attributed keen powers of observation and utter objectivity to those around him ("Because I watch myself so closely,
they must be watching me in the same way"). As he became aware of how infrequently
he attended closely to others and how limited his own observations were, he came
to realize that the attention of most people is similarly restricted, and he became
more relaxed in social situations.
♦ 5. Enlarging Perspectives with Positive Attributes
The anxious client usually takes the "worm's eye view" of his or her
situation, and as you know, one of the functions of therapy is to provide your
client with a broader perspective, that is, the "long term" or "bird's-eye"
view of the situation. For example, Logan, a college student was homesick and
afraid that her pain would last forever. The therapist helped her broaden her
perspective by looking at some of the positive attributes of her homesickness.
9 Attributes of Logan's Homesickness
Together they created the following list:
1. Her homesickness was a form
of growing pains.
2. Her homesickness was to teach her how to accept changes.
3. She was inoculating herself against future losses she would have to deal with.
4. She was demonstrating loyalty to her family.
5. By sticking out the pain instead of going home, she was putting into practice the principle of "getting
better instead of feeling better."
6. The experience was helping her
increase her tolerance of frustration.
7. Her homesickness was a socially
acceptable way to express a lot of fearful and depressing feelings.
was learning to appreciate her family more than she did at home.
pleasure follows pain, she would probably feel very good when the pain left.
Logan was able to recover from her homesickness rather quickly, and most of her
positive predictions proved to be true.
♦ 6. Reattribution
Next, let's look at Reattribution as an intervention for "What's Another
Way Of Looking At It?"
In reviewing your anxiety-prone client's automatic
thoughts, you often discover that the client's attributes to himself an excessive
amount of control for a potential negative outcome. To reattribute, you can help
the client recognize that some elements in a situation - possibly the determining
ones - are inevitably beyond his control.
Here's a specific reattribution
intervention I use.
First, the client rates the degree of responsibility he feels
he has for the feared outcome. I find this is not uncommon for a client to give
a rating of 100 percent.
I then attempt, through questioning, to reduce the estimate
of control to a more realistic level.
Depending upon the client's level of commitment
to the process, I have them list every conceivable factor that could affect the
outcome of an anxiety-provoking situation. Thus, they assess the relative degree
of influence of each factor.
Finally, they evaluate the degree of control he or
she has over each factor.
For example, Leslie, a woman sales executive,
experienced extreme anxiety when anticipating closing sessions with buyers. She
thought, "If I don't pull off a major sale, it shows I'm inept and not aggressive
enough." After a review, she recognized that she was hampered in her efforts
by a major problem: The competitor's product was superior to her own company's!
While her persuasive skills undoubtedly played a part in the outcome, they were
unlikely to be the deciding factor. This reattribution enabled her to minimize
her anxiety and address herself to the real problem.
Another client was
anxious about going to a party where she knew only a few people. She felt that
she was totally responsible for everything going well. Once she reflected on the
fact that she was only one of twenty people who would be there and that she could
not control how the others responded, she lowered her perceived sense of responsibility
and had a corresponding drop in her anxiety.
Often, the client will dislike not having more control over events. The therapist can point out the difference
between responsibility and accountability. The manager of a large division is
not directly responsible for those who work under him. He is, however, accountable
to his boss, and if he is a successful manager, holds himself accountable for
what happens in his division. A therapist is not responsible for clients but is accountable. Similarly, a client, while not responsible for those he interacts
with, can choose to hold himself accountable for his relationship with them --
that is, he had some control, both direct and indirect, over how the relationship
Peer-Reviewed Journal Article References:
Maes, M., Nelemans, S. A., Danneel, S., Fernández-Castilla, B., Van den Noortgate, W., Goossens, L., & Vanhalst, J. (2019). Loneliness and social anxiety across childhood and adolescence: Multilevel meta-analyses of cross-sectional and longitudinal associations. Developmental Psychology, 55(7), 1548–1565.
Miers, A. C., Weeda, W. D., Blöte, A. W., Cramer, A. O. J., Borsboom, D., & Westenberg, P. M. (2020). A cross-sectional and longitudinal network analysis approach to understanding connections among social anxiety components in youth. Journal of Abnormal Psychology, 129(1), 82–91.
Rodebaugh, T. L., Tonge, N. A., Piccirillo, M. L., Fried, E., Horenstein, A., Morrison, A. S., Goldin, P., Gross, J. J., Lim, M. H., Fernandez, K. C., Blanco, C., Schneier, F. R., Bogdan, R., Thompson, R. J., & Heimberg, R. G. (2018). Does centrality in a cross-sectional network suggest intervention targets for social anxiety disorder? Journal of Consulting and Clinical Psychology, 86(10), 831–844.
What are interventions to assist your client in answering the question:
What's Another Way Of Looking At It? To
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