Cbt For Social Anxiety Disorder: Using Downward Arrow And Thought Challenging Techniques

Cbt For Social Anxiety Disorder: Using Downward Arrow And Thought Challenging Techniques

Case study example for use in teaching, aiming to demonstrate how the downward arrow technique and thought challenging might be used in CBT for social anxiety disorder. The character of Hannah is played by an actor (Malak El-Gonemy), but the scene is not scripted, and as such it represents a natural therapeutic exchange.

Rather than the usual shyness advice I want to make sure you learn from people who have really gone through it. Like struggled with social anxiety for decade and come out on the other side level of gone through it. If this is your first visit to Social Professor make sure you check out the shy to social page and grab the free audiobook ‘how to talk to anyone’ which is going to turn your life around.

The video was filmed and produced by Ishan Siddiqui and Christopher Werrett.


okay so you said that when you’re at work you really worry that you’re going to say something stupid yeah that’s something that’s always on my mind what would be so bad about that if you did say something stupid at work because people would think I was weird then what would be so bad if people at work thought you are weird they wouldn’t want to be friends of me and what would be so bad about that if people that worked and want to be friends with you well I just have no one to talk to your work then what would be so bad about having our to talk to at work that’s I mean the shoots can go on the whole day so just be by myself the whole time and what would be so bad about being by yourself you know for a whole day a genero I guess I should be used to it now I spend a lot of my time by myself that must be tough what does that mean to you that you spend a lot of time on your own you know I guess it’s just like I spend so much time by myself that’s kind of like I’m not even worth being friends with so it sounds like deep down that you think that you’re not worth being friends with that’s quite quite a negative belief I mean how much would you say that you believe that out of a hundred if a hundred is where you believe it totally in zeros where you don’t believe it at all yes like ninety five hundred when did you start believing that uhm I think it was probably at school yeah and get school and what was it about school that that made you start to believe that you weren’t worth being friends with just like quite a lot of things like a wouldn’t have anyone said at lunch or people’s birthdays and stuff I wasn’t invited and you know like I was the last one picked for teams and stuff like that and what is it now that makes you think that that’s still true I mean it’s kind of similar at work obviously differences that it’s it’s worked law school but you know but people go for drinks and stuff after work or after a shoe and I just kind of excluded a lot of time mm hmm that sounds tough and is there anything that makes you think that it’s not true that that you are worth being friends with I guess my friends and family would say I am like I try to make a lot of time for my friends and stuff okay so it sounds like deep down you have this thought that you’re not worth being friends with and that started at school when you had trouble making friends at school and that you can’t always pick for teams and that now at work it feels like the same thing is happening and that you’re not always invited out for drinks with people after work and that sometimes you feel that you’re excluded from their social groups but then that’s not the whole story that on the other hand you are close to family and you do have friends who would say that it’s not true that you are with being friends with and in CBT we do a thing called thought challenging where when we have these negative thoughts sometimes we we actually put them up to two scrutiny we weigh up the evidence for and against them and I like to think of it as putting the thought on trial could we do that now where we just actually try and weigh up the evidence for and against that thought a bit more okay okay so if I just put two columns here so for and against and it sounds like the evidence for this thought that makes you think that it is true is there difficulty at school yeah making friends being picked for teams and difficulty at work feeling excluded sometimes from groups yeah but actually in this other column we have that you are close with your family and that you have some close friends okay now moving back to this first column is there anything else that makes you think it’s true that that you’re not worth being friends with oh just like I kind of don’t go to a lot of stuff and people have like gatherings and things and a lot the time I just I don’t go and okay I’ll just stay at home don’t go to parties what kind of parties are we talking like big parties small parties and mainly big ones and if there’s a lot of people there and just find it really it kind of makes me really anxious so a lot of the time I just prefer not even to be in that situation in the first place okay so you don’t go to larger parties and events okay is there anything else that maybe thinks that it makes you think that it’s not true that actually you are worth being friends with and I mean I guess my friends would say that I was and I do I do have close friends and you know and it’s like their stuff that’s important to them I always make sure that I think about that and even if I find it stressful I’ll always make sure that I can kind of put them first okay so your friends would say that you are worth being friends with yeah and it sounds like you put your friends first yeah I do make sure I try I try and do that and what kind of ways do you put your friends first and I guess when it’s birthdays or in it something important to them um I’ll always make sure that I’m there and that I put a lot of thought into presents and stuff like that can you give me an example of a time that you’ve done that and it was my friend’s birthday a few weeks ago and we did like a big surprise at hers and I made a cake and stuff like that so so you actually helped to organize events for your friends yeah is there anything that you do that you wouldn’t do if you weren’t a good friend and I guess so I kind of always put myself in situations even if I find it kind of it makes me anxious if it’s for my close friends and I know that is something that’s important to them then I’ll always put them first and make sure I’m there so you’ll tolerate your anxiety if it means something to a friend of yours yeah okay so at the moment in the four category we’ve got that you had difficulty making friends at school that you’re having difficulty now at work making friends and then you don’t go to larger parties or events but actually there’s a lot of evidence in the against column evidence that would suggest that actually you are worth being friends with and you’re a good friend that you’re close with your family you’re close with your friends your friends would say that you’re a good friend you put your friends first and even when you’re anxious you tolerate that anxiety if you know it’ll mean something to them that when things are important to your friends like birthdays and you’ll make a real effort you’ll even actually go to the effort of organizing events and baking cakes and doing things like that for other people and is there anything else that you do that makes you think that maybe you are a good friend you are worth being friends with I mean I still have my friends so I guess if I wasn’t worth being friends with though I wouldn’t have these friends I’ve had quite quite a long time okay so it sounds like you’ve got long term friendships as well so you might have trouble making friends but when you make them you stick with them yeah okay I was going to give you this list now to have a look at okay how do you feel now that you’re looking at that list and it’s weird there’s actually kind of more stuff in the against and there is in the for I guess also love the stuff that is in the four columns kind of things that I make happen like I don’t go to things hmmm yeah it seems like some of its kind of in my in my hands so it’s not that you’re not worth being friends with but actually that you’re choosing not to engage with people always yeah yeah I think so yeah okay and if I was asking now you know this idea that you’re not worth being friends with how much do you believe that now that we’ve done this exercise where 100 is where you really believe that you’re not worth being friends with in zeros that you don’t believe it um I guess I’d say maybe 40 I think I do still think that it might be true but I think I believe it less than I did before..

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Comment (8)

  1. I have been suffering from SAD for basically my entire life and have run out of (comfortable) options to cope. As of late, I have been considering going for CBT, but am worried about the process.

    Recently, I had a great friend do this to me. It began when she offered me a food that I had never tried before, I declined her offer. She then began asking me questions, a few examples being:

    “Why don’t you want to eat it?”
    “What is preventing you from trying it?”
    “What are you afraid of if you were to eat it?”

    She kept pressing me with such questions and I just began freaking out. I began sweating profusely, face went red, major heart palpitations/racing, adrenaline and of course, negative thoughts. It felt as if I was surrounded, backed into a corner with nowhere to escape. She went on and on until she could tell I was at maximum discomfort, then just stopped. During this time, I felt very offended, like she thought it was funny. As I came down from my panic, I began attempting to create small talk as if nothing had just happened. We chatted for maybe 10 minutes on and off, then she says, “You realize this was all over eating food, right?”.

    That’s when it hit me. I always knew that I was being held back by anxiety, but not to such an extent. I could not believe that a food had just caused me that much emotional pain. I now wonder what else anxiety has had me miss throughout my life. I think I may give a therapist a call.

  2. “What would be so bad about that?”
    Well…I might become suicidal because I’ve been rejected…
    “What would be so bad about th-shit hold on….uh….”

  3. social anxiety or anxiety in general is horrible,im 29 and its really held me back,isolated me,i live such a mundane life,i cant walk down the street in my local area incase i bump into someone.ive blocked my friends out over the last few years and stopped going to things but one thing i know for sure is that i will i overcome to an extent where i can deal with.watch this space

  4. what would you do if she had no friends or family? the worst of situations? I think the belief of worthiness has no factual basis except for practical reason. if you believe you are worthy of friends you are gonna feel and act differently but if you believe you are unworthy you are gonna be afraid to make friends. strange.

  5. Thank you for this video! It might help me to overcome my fear and dislike of therapists, I’ve been skipping my sessions for a while now, and watching videos like this might help me realize it’s actually not that scary and can be helpful C:
    Also thanks to the patients, and this nice lady in particular, I imagine it might have been hard to speak about your personal matters on camera and having it watched by thousands 🙂


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