Anxiety Diagnosis & Treatment of Phobias with Cognitive Restructuring Interventions

On the last five tracks we have discussed the evaluation phobias.  Two main phobias we have focused on were agoraphobia and social phobias.  The last three tracks examined social phobias and concentrated on public speaking phobias on the last track. 

On this track we will discuss 2 techniques for overcoming social phobias.  The two techniques discussed on this track are decentering and time projection.  As you listen to this track, you might consider how to implement these techniques with your client.  If he or she suffers from something other than social phobia, could these techniques still be productive?

#1  Decentering
First, let’s discuss decentering.  Decentering is the process of having the client challenge the basic belief that he or she is the focal point of social events.  Does your social phobic report thinking that everyone is watching them?  Or that others are acutely aware of the client’s tension of shyness?  Brenda, from the last track, often led herself to believe that others could read her mind. 

However, a variety of strategies is available to help clients like Brenda see that the social world does not revolve around them.  Therapists can work with the client to establish concrete criteria to determine when she is or is not the focus of attentions and what behavior or attributes are being attended to by others. 

Clearly, for the cognitive intervention of decentering to work, the client may need to adopt the perspective of another person.  A shift in focus on Brenda’s part was necessary for decentering to benefit her.  Brenda was preoccupied with her own internal reactions.  The result was that she noticed little about others’ reactions to her.  Paradoxically, Brenda attributed keen powers of observation and utter objectivity to those around her.  In one session, Brenda stated, "I know they are watching me closely, because I watch myself just as closely."  How might you have responded to Brenda? 

I stated, "You say that they are watching you in the same way as you are watching yourself.  What about how they look at themselves?"  Brenda’s response was limited, but she did agree that others likely watch themselves closely as well.  I followed by asking, "So, you’re watching yourself.  How closely do you watch others?"  Brenda stated, "I watch others rather infrequently.  My observations of them and their actions are limited."  In this way, Brenda’s cognitive set regarding others watching her changed.  She came to realize that the attention of most people is similarly restricted, and she became more relaxed in social situations. 

#2  Time Projection
Next, let’s discuss time projection.  Consider Ted, age 27.  Ted refused to engage in social functions of any kind due to his phobic disposition.  When Ted did find himself in a social situation, he engaged in selective mutism, meaning Ted chose not to speak out of fear.  Ted was part of a large, extended family which often invited him to a variety of functions.  I asked Ted to project himself into the future and imagine a social situation months or even years away. 

By doing so, I believed Ted could derive detachment from and gain perspective on social events.  For example, Ted had the following time projection.  He stated, "I imagined our fourth of July picnic that’s coming up in a few months.  I’m standing there while everyone is talking about their jobs and families and hobbies.  Nobody comes up and talks to me because they think I’m weird.  They all think, ‘There’s Ted.  Why is he here?’  I’m unable to make conversation and when someone does talk to me, I act like a retard and spill my drink." 

I suggested to Ted that he imagine that he goes to several family functions.  I stated, "After the bad incident at the fourth of July picnic, imagine that you attend several other family functions this year.  Now imagine next year’s fourth of July picnic."  Ted stated, "I see myself standing in a group.  I’m nervous about what I might say next, but I know I’ll say something." 

Think of your Ted.  Might your client be able to begin visualizing a decrease in social phobic reactions using the time projection technique?

On this track we discussed 2 techniques for overcoming social phobias.  The two techniques discussed on this track are decentering and time projection. 

On the next track we will discuss exposure.  Three techniques regarding exposure will be presented on this track.  The three techniques for exposure are the initiation technique, cognitive avoidance, and the critical decision technique. 

- Jensen, Vicki L.; Hougaard, Esben; Fishman, Daniel B. Sara, A Social Phobia Client with Sudden Change After Exposure Exercises in Intensive Cognitive-Behavior Group Therapy: A Case-Based Analysis of Mechanisms of Change. PCSP: Pragmatic Case Studies in Psychotherapy. 2013, Vol. 9 Issue 3.

-Moldovan, Ramona; David, Daniel. One Session Treatment of Cognitive and Behavioral Therapy and Virtual Reality for Social and Specific Phobias, Preliminary Results from a Randomized Clinical Trial. Journal of Evidence-Based Psychotherapies. Mar 2014, Vol. 14 Issue 1, p67-83.
Reviewed 2023

Peer-Reviewed Journal Article References:
Alden, L. E., Buhr, K., Robichaud, M., Trew, J. L., & Plasencia, M. L. (2018). Treatment of social approach processes in adults with social anxiety disorder. Journal of Consulting and Clinical Psychology, 86(6), 505–517.

Chang, V. T., Overall, N. C., Madden, H., & Low, R. S. T. (2018). Expressive suppression tendencies, projection bias in memory of negative emotions, and well-being. Emotion, 18(7), 925–941.

Erceg-Hurn, D. M., & McEvoy, P. M. (2018). Bigger is better: Full-length versions of the Social Interaction Anxiety Scale and Social Phobia Scale outperform short forms at assessing treatment outcome. Psychological Assessment, 30(11), 1512–1526.

Hayes-Skelton, S. A., Calloway, A., Roemer, L., & Orsillo, S. M. (2015). Decentering as a potential common mechanism across two therapies for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 83(2), 395–404.

Jenkins, S. R., & Nowlin, R. B. (2018). Clients’ TAT interpersonal decentering predicts psychotherapy retention and process. Rorschachiana, 39(2), 135–156.

Keesman, M., Aarts, H., Häfner, M., & Papies, E. K. (2020). The decentering component of mindfulness reduces reactions to mental imagery. Motivation Science, 6(1), 34–42.

Shoham, A., Goldstein, P., Oren, R., Spivak, D., & Bernstein, A. (2017). Decentering in the process of cultivating mindfulness: An experience-sampling study in time and context. Journal of Consulting and Clinical Psychology, 85(2), 123–134.

Zoubaa, S., Dure, S., & Yanos, P. T. (2020). Is there evidence for defensive projection? The impact of subclinical mental disorder and self-identification on endorsement of stigma. Stigma and Health. Advance online publication.

Online Continuing Education QUESTION 16
What are two techniques which can be used to treat social phobias? To select and enter your answer go to CEU Test.