ON DEMAND: Cognitive-Behavioral Therapies for Social Anxiety Disorder: An Integrative Strategy

with instructor Larry Cohen, LICSW, A-CBT

Cost $99.00

Credit Hours 6 CEs

Level Intermediate

Delivery Method Recorded Webinar

Interactivity Type Non / Self-Study*

Date Developed July 2024

ON DEMAND: Cognitive-Behavioral Therapies for Social Anxiety Disorder: An Integrative Strategy

6 clinical CEs

$99.00

ON DEMAND: Cognitive-Behavioral Therapies for Social Anxiety Disorder: An Integrative Strategy

6 clinical CEs

$99.00

Course Overview

Cognitive-behavioral therapy has been demonstrated in hundreds of outcome studies to be the most effective treatment for social anxiety disorder, the 3rd or 4th most prevalent mental health disorder in the United States (Mayo-Wilson 2014). However, there are several different CBT for social anxiety protocols, each with different emphases, although all sharing much in common.

This session provides an intensive overview of five evidence-based cognitive-behavioral strategies for the treatment of social anxiety disorder: behavioral experiments/exposure; cognitive restructuring; external mindfulness plus thought defusion; assertion training; and core belief change work (Hofmann 2017; Hope 2019; OXCADAT 2023; McEvoy 2018; Padesky 2020). Attendees will learn how to apply, combine, and adapt these strategies to the needs of socially anxious individuals. Several of these strategies will be demonstrated during the session through clinical role plays. There will also be discussion on how to design and implement exposures as behavioral experiments to test and modify automatic thoughts, underlying assumptions and core beliefs for the purpose of decreasing social anxiety and building self-confidence. Many client worksheets, instructional handouts and questionnaires are provided for use and adaptation in your own practices. Attendees will become familiarized with the major debates among the three waves of cognitive-behavioral therapies as to the most effective strategies for treating social anxiety disorder, and how to integrate the best of each of these variant approaches depending on the needs of particular clients.

Learning Objectives

Participants will develop strategies to help clients understand the impact of self-focus and self-evaluation when experiencing social anxiety, and how to train clients in the use of external mindfulness when socially anxious.
Participants will develop strategies to train clients in differing means of doing cognitive restructuring before and after social anxiety triggers.
Participants will develop strategies to help clients design, execute and learn from behavioral experiments / exposures to test socially anxious thoughts and underlying core beliefs, and to increase client motivation to carry out such experiments.
Participants will develop strategies to train clients in the use of assertive defense of the self to increase self-confidence in handling fears come true.
Participants will develop strategies to help clients identify and change underlying core beliefs that exacerbate their social anxiety.
Participants will describe what social anxiety disorder is, its impact on those who suffer from it, and what treatments have been demonstrated to be most effective.

Course Outline

Module	Topic
Module 1	Introduction Speaker intro., and intro. to NSAC Resources for therapists and for consumers Basic facts about social anxiety, and the role of shame Diversity factors in social anxiety The vicious cycle of socially anxious beliefs, automatic thoughts, feelings and behaviors; walking through an example Brief overview of outcome studies on social anxiety treatment Integrating the 3 waves: debates and syntheses Debate on accepting anxiety vs. decreasing anxiety as therapy goal The 5 core CBT treatment strategies: external mindfulness; cognitive restructuring; behavioral experiments; assertiveness training; core belief change work QUESTIONS & ANSWERS
Module 2	EXTERNAL MINDFULNESS (CURIOSITY TRAINING): Rationale Debate on external mindfulness vs. internal mindfulness (meditation) Thought and feeling defusion Introducing external mindfulness to clients with in-session experiments and video recording Clinical demonstration of introducing clients to external mindfulness in session Homework to help clients master external mindfulness while observing and participating QUESTIONS & ANSWERS
Module 3	COGNITIVE RESTRUCTURING (REFRAMING): Rationale Themes of socially anxious hot thoughts Debate on defusing from negative thoughts vs. reframing them Debate on how and when to do cognitive restructuring for social anxiety Debate on targeting verbal vs. imaginal thoughts How to introduce clients to cognitive restructuring Clinical demonstration of role-played cognitive restructuring argument Clinical demonstration of use of confident imagery to reframe hot thoughts Homework to help clients master cognitive restructuring QUESTIONS & ANSWERS
Module 4	BEHAVIORAL EXPERIMENTS (EXPOSURES): Rationale Debate on exposures for habituation vs. experiments for learning / cognitive restructuring How to choose experiments Debate on what types of experiments to choose: straightforward vs. paradoxical (social mishap, de-catastrophizing, shame-attacking); examples of both types Debate on use of fear hierarchies In-session and homework experiments Use of video for in-session experiments Clinical demonstration of use of video Introducing clients to safety-seeking behaviors and how they are self-defeating Common safety-seeking behaviors Identifying, reducing and eliminating safety-seeking behaviors Carrying out experiments: before, during and after Debate on accepting anxiety vs. defying / combatting anxiety Strategies to increase follow-through and decrease avoidance of experiments Clinical demonstration of consensual role play to increase motivation to do experiments Use of surveys as experiments QUESTIONS & ANSWERS
Module 5	ASSERTIVE DEFENSE OF THE SELF (HEAD-HELD-HIGH ASSERTION): Rationale How to practice the strategy in session and in homework Debate on the limitations of the strategy, and ways to address these limitations Clinical demonstrations (2 or 3) of practicing this strategy in role plays QUESTIONS & ANSWERS
Module 6	CORE BELIEF CHANGE WORK; ASSESSMENT, PROGRESS MONITORING, TERMINATION: Rationale Debate on whether to target core beliefs at all when treating social anxiety Themes of core beliefs in social anxiety Helping clients identify their unhealthy core beliefs Helping client write drafts of healthy new core beliefs Core belief change strategies Clinical demonstration of core belief argument Clinical demonstration of Then vs. Now Review of using scales for assessment and monitoring progress Identifying treatment goals and fear hierarchies to provide direction & monitor progress Termination strategies to maintain progress, make further progress beyond therapy, and to prevent relapse

Instructor Bio

Larry is cofounder and Cochair of the National Social Anxiety Center (NSAC), a network of many regional clinics around the United States dedicated to providing and fostering effective, evidence-based services for those struggling with social anxiety. He has directed the Social Anxiety Help clinic (NSAC District of Columbia) in Washington, DC since 1990 where he has provided cognitive-behavioral therapy for more than 1,000 persons with social anxiety, and has conducted some 100 20-week social anxiety CBT groups. Larry is certified as a Diplomate in CBT by the Academy of Cognitive and Behavioral Therapies, which has also conferred on him the status of Fellow for having “made sustained outstanding contributions to the field of cognitive therapy”.

Course Bibliography

de Ponti N, M Matbouriahi, P Franco, M Harrer, C Miguel, D Papola, A Sicimoğlu, P Cuijpers and E Karyotaki (2024). The efficacy of psychotherapy for social anxiety disorder, a systematic review and meta-analysis. Journal of Anxiety Disorders 104.

Ginat-Frolich R, E Gilboa-Schechtman, J Huppert, I Aderka, L Alden, Y Bar-Haim, E Becker, A Bernstein, R Geva, R Heimberg, S Hofmann, T Kashdan, E Koster, J Lipsitz, J Maner, D Moscovitch, P Philippot, R Rapee, K Roelofs, T Rodebaugh, F Schneier, O Schultheiss, B Shahar, U Stangier, M Stein, L Stopa, C Taylor, J Weeks and M Wieser (2024). Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives, Clinical Psychology Review 109.

Herbert, J. D., Forman, E. M., Kaye, J. L., Gershkovich, M., Goetter, E., Yuen, E. K., Glassman, L., Goldstein, S., Hitchcock, P., Tronieri, J. S., Berkowitz, S., & Marando-Blanck, S. (2018). Randomized controlled trial of acceptance and commitment therapy versus traditional cognitive behavior therapy for social anxiety disorder: Symptomatic and behavioral outcomes. Journal of Contextual Behavioral Science, 9, 88-96.

Hofmann, S.G., & Otto, M.W. (2017). Cognitive Behavioral Therapy for Social Anxiety Disorder: Evidence-Based and Disorder-Specific Treatment Techniques (2nd ed.). Routledge. https://doi.org/10.4324/9781315617039

Hope, D., Heimberg, R., & Turk, C. (2019). Managing Social Anxiety, Therapist Guide and Workbook : A Cognitive-Behavioral Therapy Approach. New York, NY: Oxford University Press.

Goldin, P. R., Morrison, A., Jazaieri, H., Brozovich, F., Heimberg, R., & Gross, J. J. (2016). Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial. Journal of consulting and clinical psychology, 84(5), 427–437. https://doi.org/10.1037/ccp0000092

Koban, L., Schneider, R., Ashar, Y. K., Andrews-Hanna, J. R., Landy, L., Moscovitch, D. A., Wager, T. D., & Arch, J. J. (2017). Social anxiety is characterized by biased learning about performance and the self. Emotion (Washington, D.C.), 17(8), 1144–1155. https://doi.org/10.1037/emo0000296

Leigh E, Chiu K, Clark DM (2020) The effects of modifying mental imagery in adolescent social anxiety. PLoS ONE 15(4): e0230826. https://doi.org/10.1371/journal.pone.0230826

Liu X, P Yi, L Ma, W Liu, W Deng, X Yang, M Liang, J Luo, N Li and X Li (2021). Mindfulness-based interventions for social anxiety disorder: A systematic review and meta-analysis. Psychiatry Research 300.

Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The lancet. Psychiatry, 1(5), 368–376. https://doi.org/10.1016/S2215-0366(14)70329-3 NOTE: This is a meta-analysis of 101 trials of differing treatments for social anxiety disorder.

Mc Evoy, P. M., Saulsman, L. M., & Rapee, R. M. (2018). Imagery-enhanced Cbt for Social Anxiety Disorder. The Guilford Press.

Oxford Centre for Anxiety Disorders and Trauma (2023). Cognitive Therapy for Social Anxiety Disorder; a series of online training videos by OXCADAT. https://oxcadatresources.com/social-anxiety-disorder/.

Padesky, Christine (2020). CBT for Social Anxiety: Assertive Defense of the Self; audio and video recordings of training semimars. https://payhip.com/b/bt593 and https://payhip.com/b/dZT2R .

Riccardi C, K Korte and N Schmidt (2017). False Safety Behavior Elimination Therapy: A randomized study of a brief individual transdiagnostic treatment for anxiety disorders. Journal of Anxiety Disorders 46: 35-45.
Romano, M., Moscovitch, D. A., Huppert, J. D., Reimer, S. G., & Moscovitch, M. (2020). The effects of imagery rescripting on memory outcomes in social anxiety disorder. Journal of anxiety disorders, 69, 102169. https://doi.org/10.1016/j.janxdis.2019.102169.

Approvals

Cognitive Behavior Institute, #1771, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 06/30/2022-06/30/2025. Social workers completing this course receive 6 clinical continuing education credits.

Cognitive Behavior Institute, LLC is recognized by the New York State Education Department's State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0098 and the State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0646 and the State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors #MHC-0216.

Cognitive Behavior Institute has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7117. Programs that do not qualify for NBCC credit are clearly identified. Cognitive Behavior Institute is solely responsible for all aspects of the programs.

Cognitive Behavior Institute is approved by the American Psychological Association to sponsor continuing education for psychologists. Cognitive Behavior Institute maintains responsibility for content of this program.

Social workers, marriage and family therapists, and professional counselors in Pennsylvania can receive continuing education from providers approved by the American Psychological Association. Since CBI is approved by the American Psychological Association to sponsor continuing education, licensed social workers, licensed marriage and family therapists, and licensed professional counselors in Pennsylvania will be able to fulfill their continuing education requirements by attending CBI continuing education programs. For professionals outside the state of Pennsylvania, you must confirm with your specific State Board that APA approved CE's are accepted towards your licensure requirements. The Association of Social Work Boards (ASWB) has a process for approving individual programs or providers for continuing education through their Approved Continuing Education (ACE) program. ACE approved providers and individual courses approved by ASWB are not accepted by every state and regulatory board for continuing education credits for social workers. Every US state other than New York accepts ACE approval for social workers in some capacity: New Jersey only accepts individually approved courses for social workers, rather than courses from approved providers. The West Virginia board requires board approval for live courses, but accepts ASWB ACE approval for other courses for social workers. For more information, please see https://www.aswb.org/ace/ace-jurisdiction-map/. Whether or not boards accept ASWB ACE approved continuing education for other professionals such as licensed professional counselors or licensed marriage and family therapists varies by jurisdiction. To determine if a course can be accepted by your licensing board, please review your board’s regulations or contact them. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit.