Social behavioral therapy (CBT) is used to treat SAD.

      Social anxiety is a frequently seen disorder within society. Social anxiety disorder is a fear of social situations for the individual. People with social anxiety fear that a social interaction will lead a too negative impacting response to themselves. (Farmer, Kashdan,  Adams, Mcknight, Ferssizidis, Nezelf 2013). Social anxiety disorder (SAD) is defined as fear of rejection and being negatively judged by other. SAD can lead to complete prevention of social interactions with others (Farmer, Kashdan,  Adams, Mcknight, Ferssizidis, Nezelf, 2013).  Cognitive behavioral therapy (CBT) is used to treat SAD. In numerous studies, Cognitive behavioral therapy (CBT) training shows to be highly effective when treating patients with SAD. Cognitive behavioral therapy shows it has long and short-term effectiveness (Hambrick, Weeks, Harb, & Heimberg, 2003). CBT is a psychotherapeutic treatment used on the idea that behavioral and cognitive approaches can help cope with SAD (Hope, Burns, Hayes, Herbert, Warner, 2007). The most commonly used techniques are exposure to a commonly feared social situation, social and skills training and cognitive restructuring,  (Hambrick, Weeks, Harb, & Heimberg, 2003). These techniques show positive results when used. Pharmacotherapy as a treatment used for SAD showed the fastest results in the studies, but a much greater chance of relapsing. New studies showed avoidance of social situations is a major component in SAD, with the use of CBT this component of SAD can be treatable. (Farmer, Kashdan, Adams, Mcknight, Ferssizidis, Nezelf 2013). Social anxiety is fear of communication with other individuals and it may bring feelings of self-consciousness (Farmer, Kashdan, Adams, Mcknight, Ferssizidis, Nezelf, 2013). Research has indicated the people with SAD are more likely to avoid interactions, experience negative emotions, and have negative life events as opposed to people without SAD (Farmer, Kashdan, Adams, Mcknight, Ferssizidis, Nezelf, 2013). Studies have found the people with SAD try to hide their emotions when in a social situation. This provides a theory that people with SAD that try and conceal their emotions use this as a security blanket to avoid negative interactions and experiences. There are many risk factors involved with someone having SAD. Having SAD can lead to few or no friendships, less satisfaction with the number of friends, less likely to be married, more likely to live alone, be unemployed, and reduced work productivity (Hambrick, Weeks, Harb, & Heimberg, 2003). People with SAD are more prone to being submissive and unassertive (Farmer, Kashdan, Adams, Mcknight, Ferssizidis, Nezelf 2013). Rapee and Heimberg developed a model to describe anxiety in social or evaluative situations. The model says that an individual may see a social situation as a threat with negative consequences (Roth & Heimberg, 2001). Rapee and Heimberg propose that a person with SAD embraces high standards for themselves and their peers do as well (Roth & Heimberg, 2001). Rapee and Heimberg also suggest that a person with SAD imagines the audience judging them and evaluating every move they make (Roth & Heimberg, 2001). SAD increases when a person is in a social situation where they feel threatened by the audience (Hambrick, Weeks, Harb, & Heimberg, 2003). A person with social anxiety may imagine how the audience visualizes them from past experiences and memories (Hambrick, Weeks, Harb, & Heimberg, 2003). This leads a person with social anxiety to a prediction of how the outcome of their performance will be (Hambrick, Weeks, Harb, & Heimberg, 2003). The model starts with the perceived audience then it flows to a mental representation of self as seen by the audience (Roth & Heimberg, 2001).  Then the chart explains that a comparison of the mental representation of self as seen by the audience with an appraisal of audience’s expected standard (Roth , 2001). The model flows to the judgment of probability and consequences of negative evaluation of audience (Roth , 2001). Then the chart flows to three items, behavioral symptoms of anxiety, cognitive symptoms of anxiety, and physical symptoms of anxiety (Roth , 2001). Then the chart flows to either external indicators of evaluation or perceived internal cues (Roth , 2001). Then the chart repeats itself by going back to mental representation of self as seen by the audience (Roth , 2001). A person with SAD sees himself or herself as in outsider taking on an observer’s perspective (Roth & Heimberg, 2001).  When treating social anxiety in a patient, the therapist observes, coaches, and teaches coping skills to that patient (Hambrick, Weeks, Harb, & Heimberg, 2003). When using CBT it helps the patient change their behavior on their own with a push from the therapist. The therapist and patient work together to surpass the social anxiety the patient has. The patient learns how to use the skills learned in CBT and assess them in everyday life (Hambrick, Weeks, Harb, & Heimberg, 2003). There are numerous cognitive behavioral techniques to treat social anxiety. The most widely used techniques that can be used are exposure to a feared social situation, cognitive restructuring, relaxation training, social and skills training. The technique of using exposure therapy is vital for progress in SAD (Hambrick, Weeks, Harb, & Heimberg, 2003). To start therapy a patient must tell the therapist what social situations entice the symptoms of social  anxiety (Hambrick, Weeks, Harb, & Heimberg, 2003). The patient then must confront these situations starting with the less feared situation. The patient is then told to stay in the setting until the anxiety is lowered and eventually dissipates (Hambrick, Weeks, Harb, & Heimberg, 2003). Eventually, the patient is exposed to higher social anxiety settings. The social setting may be role playing, in a social setting, or imagery (Hambrick, Weeks, Harb, & Heimberg, 2003). The only negative factor is that the patient must fully focus on the situation at hand instead of blocking it out (Hambrick, Weeks, Harb, & Heimberg, 2003). Cognitive restructuring helps the patient with social anxiety by determining the negative thoughts that happen before, during, or, after a feared social situation (Hambrick, Weeks, Harb, & Heimberg, 2003). Then the patient and therapist assess these issues with dialogue and behavioral experiments (Hambrick, Weeks, Harb, & Heimberg, 2003). The outcome of this technique helps the patient understand that their thought process of how a social situation will occur is not always right (Hambrick, Weeks, Harb, & Heimberg, 2003).  Relaxation training may help the patient manage social anxiety if effective (Hambrick, Weeks, Harb, & Heimberg, 2003). The techniques used originated from the work of Wolpe, Bernstein, and Borkovec (Hambrick, Weeks, Harb, & Heimberg, 2003). The idea of relaxation training is to relax a certain group of muscles. The exercise used focuses on a certain group of muscles then tensing those muscles for a certain amount of time and then relaxing those muscles once more (Hambrick, Weeks, Harb, & Heimberg, 2003). The process helps the patient notice the difference in relaxing and tensing of the muscles (Hambrick, Weeks, Harb, & Heimberg,  2003). Hambrick, Weeks, Harb, & Heimberg explain that there are three skills that happen in treatment. These skills are noticing early feelings of anxiety and physiologic arousal, accomplishing a relaxed state quickly, and using the relaxation training when an anxiety situation is occurring (Hambrick, Weeks, Harb, & Heimberg, 2003).  Social skills training can help the patient with certain aspects of the social anxiety. Eye contact and conversation skills are examples are what a patient lacks when in a social situation (Hambrick, Weeks, Harb, & Heimberg, 2003). Hambrick, Weeks, Harb, & Heimberg, (2003) explain that there are different techniques used in social skills training. The techniques used are therapist modeling, behavioral rehearsal, corrective feedback, social reinforcement, and homework assignments (Hambrick, Weeks, Harb, & Heimberg, 2003). CBT shows short-term and long-term outcomes (Hambrick, Weeks, Harb, & Heimberg, 2003). In a study done by Chambless and Hope, it showed that the outcome of CBT and cognitive group behavioral therapy (CGBT) compared with wait-list control and supportive counseling as an overall better treatment (Hambrick, Weeks, Harb, & Heimberg, 2003).  In a study done by Feske and Chambless used exposure treatment combined with cognitive restructuring and then only used exposure therapy on patients (Hambrick, Weeks, Harb, & Heimberg, 2003). The results indicated a similar outcome but using only the exposure therapy seemed to get better outcomes.  Taylor did a study of three groups using the combined techniques cognitive restructuring, exposure therapy, social skills training and then comparing them to using pure cognitive restructuring and exposure therapy outcomes (Hambrick, Weeks, Harb, & Heimberg, 2003). The results of Taylor’s study of groups did not have different outcomes (Hambrick, Weeks, Harb, , 2003). Hambrick, Weeks, Harb, that a combination of CBT techniques and only using one technique shows little or no different outcome. The research does however show that CBT is an effective treatment for SAD (Hambrick, Weeks, Harb, , 2003) Studies show that CBT helps the patient improve cognitive appraisal strategies in social situations.  In a study done by Hope, Burns, Hayes, Herbert, & Warner (2007), the subjects were given a twelve-week session. Each session lasted 2 hours and included five to seven patients and two therapists. Role-play, cognitive restructuring, and exposure therapy  was used in each session. The results of the sessions indicate that CBGT does help the patients cope with SAD (Hope, Burns, Hayes, Herbert, Warner, 2007). Numerous medications are used to treat SAD. Paroxetine, sertraline, fluvoxamine, phenelzine, benzodiazepine, and gabapentin are just some medications used to treat SAD. Research indicates that there is a greater relapse when taking only medication than in CBT (Hambrick, Weeks, Harb, , 2003). A study done by Heimberg and colleagues compared CBT with the medicine phenelzine. The outcome showed a faster response to phenelzine, but a relapse after 6 months. The CBT group did not have such a high rate of relapse than the phenelzine group (Hambrick, Weeks, Harb, , 2003). Another study done by Liebowtiz showed that patients who received CBT over phenelzine relapsed once the medication was discontinued (Hope, Burns, Hayes, Herbert, Warner, 2007). Overall using pharmacotherapy instead of CBT shows a greater chance of relapse, but quicker results (Hambrick, Weeks, Harb, , 2003).  Social anxiety is a fear of being negatively judged by others. Social anxiety can affect one’s everyday life and cause one to avoid social situations. The use of treatment though can help one surmount or cope with social anxiety. Cognitive behavioral therapy is proven to work for Social anxiety disorder.       References Hambrick, J. P., Weeks, J. W., Harb, G. C., & Heimberg, R. G. (2003). Cognitive-behavioral 1 therapy for social anxiety disorder: Supporting evidence and future directions. CNS Spectrums, 8(5), 373-381.  Hope, D. A., Burns, J. A., Hayes, S. A., Herbert, J. D., & Warner, M. D. (2010). Automatic  thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder. Cognitive Therapy And Research, 34(1), 1-12. doi:10.1007/s10608-007-9147-9 Roth, D. A., & Heimberg, R. G. (2001). Cognitive-behavioral models of social  anxiety disorder. Psychiatric Clinics Of North America, 24(4), 753-771. doi:10.1016/S0193-953X(05)70261-6   Kashdan, Todd B., Antonina S. Farmer, Leah M. Adams, Patty Ferssizidis, Patrick E.  McKnight, and John B. Nezlek. 2013. “Distinguishing healthy adults from people with social anxiety disorder: Evidence for the value of experiential avoidance and positive emotions in everyday social interactions.” Journal Of Abnormal Psychology 122, no. 3: 645-655.PsycARTICLES, EBSCOhost (accessed December 3, 2013).   Willutzki, U., Teismann, T., & Schulte, D. (2012). Psychotherapy for social anxiety disorder:  Long?term effectiveness of resource?oriented cognitive?behavioral therapy and cognitive therapy in social anxiety disorder. Journal Of Clinical Psychology, 68(6), 581-591. doi:10.1002/jclp.21842