Social Anxiety Disorder: Everything We Need to Know but Are Afraid to Ask (January 2025)

Course Overview

The Core Components of Effective SAD Treatment
This seminar presents an overview of the CBT conceptualization of SAD, and the core components of evidence-based treatment of SAD (Mayo-Wilson et al, 2014; Ginat-Frolich et al, 2024):

• behavioral experiments / exposures (Clark, 2023a)
• objective of learning vs. short-term habituation while pursuing life goals
• identifying and dropping safety-seeking behaviors
• straightforward and paradoxical experiments
• in-session, video, virtual reality, in vivo and homework experiments
• attention training / external mindfulness vs. meditation (Cavin, Janecka and Clark, 2016)
• cognitive restructuring
• analysis of evidence generated by experiments
• to target rumination/worry and avoidance
• assertive defense of the self
• core belief change work

Exploring Schema Therapy with Social Anxiety and Avoidant Personality Disorder
This presentation will help you understand some of the key concepts of schema therapy as applied to social anxiety and avoidant personality disorder. Schema therapy is an evidence-based treatment approach based on decades of its study for borderline personality disorder. Research on its effectiveness with Axis 1 disorders like social anxiety is more recent. You’ll learn some of the basic differences between schema therapy and traditional CBT for social anxiety and avoidant personality disorder. We’ll explore what research says about schema therapy for social anxiety and avoidant personality. We will examine schemas and schema modes common with social anxiety and avoidant personality disorder. Schemas are broad, pervasive and dysfunctional personality themes regarding oneself and one’s relationship with others, developed during childhood when one’s needs are not met. Schema modes are activated when a schema is triggered and reflects one’s current mood state and resulting cognitions and behaviors. Schemas and modes are specific to each patient and it is not accurate to label which schemes will show up for any given patient regardless of the disorder. That given, we will look the social isolation schema in more detail, which is one of the schemas commonly seen with social anxiety and avoidant personality.

Co-Morbid treatment of SAD and OCD
With OCD, comorbidity is the rule, not the exception. Lifetime prevalence of OCD patients with social anxiety disorder stands at 14% (2021). Knowing how to make clinical decisions on this treatment in combination will prove useful for a wide array of clinicians.

Understanding Social Anxiety in Generations Z and Alpha and What We Can Do to Help
Dubbed “the anxious generation” and “the loneliest generation,” over 60 percent of Generation Z (people born between 1997 and 2012) report experiencing significant stress and anxiety, including social anxiety (Harmony Healthcare IT, 2023). During this session, the presenter will discuss some of the unique challenges contributing to the high incidence of social anxiety among Gen Z, their typical social anxiety profile, and strategies you can use to help this group cope with the far-reaching effects of this mental health concern. Concepts will be illustrated with case studies and informed by evidence-based research (Clark & Wells, 1995; Leigh & Clark, 2021; Lyngdoh et al., 2021).

Sex and SAD: The Impact of Social Anxiety on Sex and Intimacy
The Stigma Surrounding Sexual Health in Therapy
Discussing sexual health can be difficult for both clients and therapists due to stigma and discomfort. Here we will explore the importance of normalizing sexual health discussions in therapy to reduce stigma and improve client outcomes (Brotto & Nagoski, 2018).

The Role of Media, Pornography, and Misinformation
Media and pornography often reinforce negative perceptions and fears around sexual performance, contributing to anxiety related to judgment and evaluation (Bilal & Abbasi, 2020). This section explores the impact of these external factors and how they exacerbate social anxiety in sexual contexts.

Social Anxiety’s Impact on Sexual Satisfaction and Functioning
SAD can significantly affect sexual satisfaction and functioning by increasing anxiety sensitivity and negative emotional responses during intimate encounters (Byers et al., 2022). We examine how anxiety manifests in the bedroom and the specific challenges it presents for different individuals.

Gender and Sexual Orientation Considerations
Social anxiety manifests differently depending on a person’s gender and sexual orientation, with higher prevalence rates and distinct challenges for women and gender-diverse individuals (Farhane-Medina et al., 2022; Van Minnen & Kampman, 2020). This part of the seminar highlights these differences and tailors treatment approaches accordingly.

Cognitive-Behavioral Therapy (CBT) for Sexual Anxiety
Cognitive-behavioral therapy is a well-established intervention for sexual dysfunction and performance anxiety (Metz, Epstein, & McCarthy, 2018). This section presents specific CBT strategies that help clients manage anxiety, including cognitive restructuring, exposure therapy, and mindfulness techniques to reduce anxiety and improve sexual experiences (Fakhraei, 2020; Olthuis et al., 2023).

Common Challenges in Treating Sexual Anxiety
Treating sexual anxiety can present unique challenges, including reluctance to discuss intimate concerns and difficulty in sustaining behavioral changes. Strategies for overcoming these barriers, informed by the latest research on sexual dysfunction and anxiety disorders (Yang et al., 2023), are discussed throughout the seminar.

Suicidality and Social Anxiety Disorder
Approximately one-third of individuals with social anxiety disorder (SAD) report a lifetime history of suicidal ideation (Cougle et al., 2009), with a point prevalence rate of approximately 16% being reported in a primary care setting with 18% having a history of suicide attempts (De La Vega et al., 2018). Research has suggested that the factors of "thwarted belongingness" and "perceived burdensomeness" described in the Interpersonal Theory of Suicide (Joiner, 2005) may be particularly relevant as risk factors that are likely to operate in SAD (Buckner et al, 2017; Duffy et al 2020; Chung et al 2022).

SAD has high rates of comorbidities, with 69 to 81% of affected individuals experiencing comorbid mental health conditions. Research has noted that comorbid diagnoses within this population exacerbates suicidality (Kovunca et al., 2019). Maladaptive perfectionism and over control are transdiagnostic factors that have been found to be linked to suicidality (Moscardini et al, 2022; Lynch 2018). Both factors have been reported to occur in social anxiety disorder, particularly when there is co-morbidity with disorders like depression.

Assessing clients for suicide risk and increasing their safety:
Assessment for suicide risk involves a process of evaluating the level of risk for imminent suicide in the patient with a focus on identifying risk factors that can be modified and protective factors that can be enhanced. The level of risk informs the provider on how to proceed in terms of the nature of intervention. In the case of patients with mild to moderate level of risk the focus is on keeping the individual safe and reducing the risk of suicide. An important strategy that is used at this stage is safety planning.

Treatments that target suicidality:
Evidence based treatments that target suicidality include:
 

1. Cognitive Behavior for Suicide Prevention (CBT-SP)
2. Collaborative Management and Assessment of Suicidality (CAMS)
3. Attachment Based Family Therapy (ABFT)

Learning Objectives

Course Bibliography

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.