Episode #151

Crippling Social Anxiety & CBT

Many people struggle with anxiety. But what do you do when your anxiety levels in social situations become crippling?

You deserve to be able to enjoy your life!

Join me, Dr Julie Osborn, as I share with you the CBT tools that can help you address crippling society anxiety.

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Full Episode Transcript

Hi, it's Dr. Julie. Welcome to My CBT Podcast. I'm a Doctor of Psychology and a Licensed Clinical Social Worker specializing in Cognitive Behavioral Therapy. I'm here to help you bring the power of CBT into your own life.

So I hope everybody's doing well. I wanted to read a recent email I received from a long-time listener, which I always appreciate.

And she said,

“Hello, I'm glad I picked up the My CBT podcast again because the tough week in CBT episode describes what I'm going through I had been really sad, reached out to counseling. They recommended the Mind Over Move book, so I've been reading and doing the activities. But then I flung into anxiety and a feeling loss of control until I started having headaches, nausea, painful indigestion, and heart palpitations. I feel like I'm transitioning from, I can't cope to, I can't hold the stress, it's hurting me. So I'm trying to balance using my tools or trying to let go of the pressure to feel better faster.”

So thank you to my listener for reaching out. And I just thought I'd share that with you guys that sometimes we do go back and forth.

We're not always consistent with therapy or using our tools or maybe listening to my podcast. But I'm always here for you. The books here, the tools are always available. So definitely take some commitment. I've shared with my clients that I understand the commitment it does take to work and to show up for yourself I get to practice this five days a week because working with my clients. But if I was in your shoes, to have to have the book out, I probably would schedule time. I'd have reminders on my phone to sit down and do the work. But it definitely pays off. And like I tell everybody, the more you put into it, the quicker you're going to get better. And the workbooks that I recommend are just temporary. It's like if you're in class in college, right? You're learning a class, You're learning math, say, for example, and once you got it, you got it, and you don't have to go to the book anymore. You have the information in your head, and that's with CBT, as I've shared that it can definitely change your brain chemistry when you start thinking in a more balanced way.

So Once you learn the tools and you repeat them over and over again, it will become just habit. And all of us have negative moods because we're human beings, and that's not a bad thing. But when it does happen, we just want to get into the habit of saying to ourselves, what am thinking about that's making me feel this way? And is that a hot thought? And if it is a hot thought, how can I balance that out better? So I recognize that I'm in my thoughts a lot quicker than I was before I knew CBT, and I'm able to deal with whatever is on my mind and address it and come up with better ways of thinking and maybe changing behaviors and making my negative moods more manageable. So again, all our moods are good. We want all of them. We're not just looking to have good moods all the time. We want to have that whole range so we're engaged in our lives and we can connect to others in understanding how we feel, how they feel. So it's all good stuff. It's all the balance. It's all the balance. So Today, I got a suggestion for a podcast that I thought I would do, and it's going to talk about anxiety, but I thought, it's always a good topic to come back to because it's probably what I treat the most regarding my clients.

Anxiety, if I share it in other podcasts, is if you think of an umbrella, anxiety is the umbrella, and then there's lots of different types of anxieties underneath that umbrella. And so today, I was going to talk about when you have crippling anxiety and how you can face others and how you can face your future when you just feel like it's just taking you over and you just don't know how to get past it. And a lot of people feel that way. And what they usually do is just avoid and they just don't do it or with their thoughts, they give themselves permission like, well, it's not that important or I'll do it tomorrow or maybe next time or when I feel more comfortable. These are all your thoughts. This is what you're telling yourself that allows you to avoid. Because remember, with the cognitive therapy, just a quick little review here is your thoughts create your moods. Your moods affect your behavior and your physical reaction, and then your environment. So you're feeling the thought of like, Oh, I need to go, or I should go to that party and meet up with friends, and then I feel anxious because then I tell myself all the things I just said, They won't miss me.

It's not a big deal. I'll get together with them next time. So then your behavior is to just avoid. And you just don't get past it until you put yourself out there. With anxiety, the number one way to get past it is exposing yourself to what the discomfort is. And to see that even if it wasn't the greatest night of my life, I got through it, I was okay. And you know what? I had some nice times connecting with my friends here and there, or I did enjoy the music if you went out to listen to a band. You can pick out some things that went well. But I want to give you some specific tools, since it can be so overwhelming, how to face others without having the crippling anxiety that gets in your way. A lot of people, and I've seen this, too, have shared that they've seen people with a T-shirt or sweatshirt, and it says, your anxiety is lying to you. And I said, yeah, what does that mean? Your anxiety is lying to you means your anxiety, because you're so focused on how you're feeling, it's telling you you can't handle it, you can't cope.

Terrible things will happen. And those are all lies. And that's what that sentence means, which I do love, that your anxiety is lying to you, that it's telling you or you're telling yourself things that are not 100% true. Lots of hot thoughts. And we to address those so you can get past it. And again, since that interpersonal anxiety can be so overwhelming, you definitely need tools to help you face social situations with some confidence. And again, it's tools. I always say, hope is not a plan. Don't just go out and hope things will go well, because most likely you won't show up or you're going to leave or you won't have a good time because you're going to be so wrapped up in your head with the anxiety that you're not even present. I want you to be able to be present and enjoy your life. It's really important and you deserve that. The first thing is you want to start small. When I was saying exposure, exposure therapy, as they say, is, again, the best way to get past your social anxiety, but you want to just do it gradually. If it's just too daunting to go into these large settings, just start with some one-on-one interactions and you want to work your way up.

In the Mind Over Mood book that I use mostly, by Dr. Greenberger and Dr. Podesky, in Chapter 14, which is called Understanding Anxiety, there's actually a fear ladder. Basically, what that is, is if you think of a ladder, you start at the bottom and you walk up to get to the top. So what you do, and you could do this just on a piece of paper, on the top, you would put what your goal would be, is to be able to go to, let's say, a concert. That's a big group with three of my friends. They invited me. So that's where I want to get to. But I'm going to start small and work my way up that ladder. So I got a plan. So I'm going to just start hanging out with one of my friends, and then maybe at their house or invite them over. Next time we can go out to maybe coffee shop where there's more people around and hang out. Then we can maybe add another friend. Just really baby steps, because then you can build up your confidence and be like, Oh, that went well. That was really fun.

I wasn't even aware of the other people around because I was so engaged in the conversation with my friend. That type of thing is what I'm talking about. The fear ladder is that this is something I fear, but I'm going to work my way up till I reach my goal. There's examples. If you're using the mind over mood book, there's examples in there of other things that people were working on that they had fears, but this is something you could do. That's the gradual exposure. You don't have to jump in the ocean, as they say, and put your toe in the pool or the baby pool just to get started. That would be something to think about, what are some first steps I could take? If you have some people you really trust in your life, let's say these friends I'm talking about you want to go to the concert with, share with them what you're going through and what you're working on. And would they come over and just hang out with you a little bit? Then you guys could go, like I said, to a coffee shop or wherever you I'm going to go do, and then assess at the end like, Oh, that was fine.

I felt okay. What I'm telling myself, it is true that my anxiety is lying to me because none of what I'm telling myself is true. It's just getting in the way of me having the life that I want. So That's one tool, the gradual exposure. Another one, which I talk about all the time with CBT, is challenging your thoughts. Write down what your hot thoughts are. Somebody who's anxious might have thoughts like, They'll judge me. I won't be able to handle it. I'm going to have an anxiety or a panic attack. Everybody will be staring at me. Everyone will see that I'm uncomfortable. These are all hot thoughts. Most thoughts connected with your anxiety will be hot because they're about the future and we don't know what's going to happen. We're just making assumptions. We want to identify what are my hot thoughts? What am I, again, telling myself that's getting in the way of me being able to go out into the world and enjoy myself. Then if you're doing the thought record, you're going to take that hot thought and you're going to challenge it. For example, if your hot thoughts, they're going to judge me, you may end up with a balanced thought of I've had good interactions with others before, and I don't know what anyone's thinking.

Writing down, Is there any truth that they'll judge me? You don't really have any evidence to support that because you don't know what people are thinking. But the evidence that does support it, again, is you've had good interactions, you don't know what people are thinking. Even if they are judging me, I'm not going to know what they're thinking, and I can still be focused and enjoy my time with my friends. Again, it's balanced thinking. Maybe they will judge you. I have a podcast called Are You Judging Me? And I talk about how everybody judges everybody. People make judgments all the time. We don't know what they're thinking. They don't know what we're thinking. It's not really a big deal. No one's in our face telling us how terrible we are or they think we're silly or whatever the situation is. If we allow people to have that much power over our lives, we're just not going to be able to move forward. But that's just one thing about they're judging I'm going to have an anxiety attack. I don't know what's going to happen. It hasn't happened yet. Those are really good hot thoughts to challenge by using the thought record.

You could also do another two of Some of the role-playing. It goes back to a little bit with my example with the gradual exposure, is you can practice conversations with a trusted friend, or if you have a therapist to build the confidence. Just role-play and have Say things. If you're role-playing, I'd have the other person be you. If I were you, I would throw things out that you're thinking, words or thoughts that you're scared might come true. What's in your head? Let the other person challenge those thoughts back and forth. Even though you may still be anxious, if you know what you're going to say if something happens, or what are you going to do if you're feeling anxious, when you have a plan, an action plan, I like to call it, you will feel less anxious. So if I do start feeling anxious and I'm at the concert, I'm going to just maybe go to the bathroom. If it's a type of concert, you could step outside or you could go somewhere where it's not as crowded. I'm going to go over and just do so in my breathing exercises. Whatever that is, have a plan.

So if it happens, you know what you're going to do, but it may not happen at all. And again, it gives you that confidence that if it does happen, I can handle it, and I really want to go and live my life and have fun and really to this concert or event with my friends. Doing the role-playing can build up that confidence of like, Oh, there's things I can do. Another tool you can do is what we call self-compassion exercises. This is also what I call double standard technique. You want to treat yourself as you would a friend. When you're nervous, you want to remind yourself saying, It's okay, I feel this way. I'm doing my best. What would I say to my friend if they came up and said, Oh, my God, I'm so anxious to go. I won't be to handle it. What would you say? Most people, when I ask them to do this exercise, they answer in about two seconds, because we just know what we would say, and we tend to be compassionate, loving. I always tell everybody, what you just said to your friend is the answer for you as well.

What would I say and how would I treat my friend? I'm going to treat myself that same way. Having that self-compassion. It's okay, and maybe even normal in some circumstances to feel nervous, going into new social situations, but I can handle it. And I'm not going to let my anxiety keep me stuck at home and have a very small world and then get even more anxious and depressed. It's okay. I know what to do. I got good support with me. I have my tools. I'm going to use them. And then another tool that you can use is called grounding techniques. So there's something called the 5, 4, 3, 2, 1 method. It says to identify five things you can see, four things you can touch, three things you can hear, two things you can smell, and one you can taste. When you do this exercise, it keeps you anchored in the present moment. Instead of your anxiety just making you feel even light-headed and just overwhelmed, it's like, Okay, what are five things I can see right in front of me? What are some things I can touch? What am What can I hearing? What can I smell?

Is there something I can even taste? It keeps you present. And when you're present, it's harder to be anxious because you're not thinking about all these other things. Let's say you are really at a concert, focusing on the music, singing the songs. That will keep you more grounded. If your friend's next to you and you want to touch their arm, hold their hand. That's something you can touch. There's something you can smell in the air. Whatever that would be for you. It's just a way to get more present. Where am I? What am I doing? Again, it's the 5, 4, 3, 2, 1 method, and that helps ground you. And being grounded helps decrease your anxiety. Those are some things you can do when you're going out into the world and facing others and not having, again, this crippling anxiety because you deserve that. Now, let me talk also about facing your future without crippling anxiety. Because, again, anxiety is all about future things, and that's why it makes us anxious because we don't have the answers and we don't know what's going to happen. And fear of the unknown just fuels your anxiety. Obviously, CBT tools can help with that for sure.

Regarding your future, if you're thinking about your future and you're really... I talked to a lot of college students, they're like, Oh, my God, am I taking the right major? Am I taking the right What happens if I can't get a job with this major? Or am I picking the right career or the right partner? Oh my God, a million things. The first thing, again, just as I said earlier, is you want to focus on the present. Using mindfulness techniques such as deep breathing, doing some meditation, can reduce your future-focused worries. Being mindful keeps you present. Doing some breathing. My favorite, I've shared with you guys is the 4-7-8 breathing technique. You can look it up on YouTube, and there's a whole video with Dr. Andrew Weil that goes over the 4-7-8 breathing. That's the one my clients find most helpful. Doing some meditation, listening to a meditation app, taking a walk, feeling your feet on the ground, whatever helps you give more present can help you get away from that fear about the future. Another tool you can use is just breaking down your goals. So this goes back to that action plan I talk about.

And there's an action plan, again, mind over mood in Chapter 10, it breaks that down for you. But instead of telling yourself, I need to figure out my entire future, Instead, you can say, What's the next step I can take today? Can I go interview somebody or talk to someone I know that's in my career? I talk to a lot of people, my clients, that want to do what I do, and we talk about what's the best degree for what they want to do and what does that look like. And I share my story about how I got directed into being a social worker. What's the next step I can take today to give more clarity, to answer some questions to help me make some decisions about what I want to do with my future, what direction I want to go in, what's important to me. There's so many things about future that people make decision regarding if you're going to get married or not. And then if you want to have kids, that's another biggie. Those are deal-breakers for some people. If I'm not sure, let me go talk this through with somebody. I know a lot of people say, Oh, you'll change your mind when you get older, or, Oh, just wait and see.

But if you're in a relationship with someone, that's a big deal for somebody else. It's not really a wait and see if I'm going to change my mind. That's a big commitment having a kid. Just as an example. But again, you really want to take the time, educate yourself. If it's a career, if it's school, if it's relationship, maybe that's good to get into some therapy and talk that through and see what's important to you. But you want to break it down into smaller goals so it's manageable and you can focus on it. Another fun CBT tool is called worry time, where you actually schedule it. Every day, you can take 15 to 20 minutes to focus on your worries. How does this help you? Is it keeps your anxiety from dominating your entire day. So instead of worrying all day, you can say, okay, every day at four o'clock, when I finish work, I'm just going to sit in my car or in my office, and I'm just going to worry about every possible thing I could worry about. Worry, worry, worry, worry, worry. And how this works, usually if you're doing it every day, is people get sick of it and they let their worries go.

It actually helps. It actually works. So if during the day you're like, oh, yeah, that's concerning me. Oh, yeah, I need to worry about that. And you could say, Oh, at four o'clock, I get to do that. I can focus on my work and get this project done because I'm going to have time to worry. I don't have to worry about it now thinking I'm going to forget about it. You can have a little piece of paper if you think about a worry during the day and put it on your list for your four o'clock worry time. But it is a tool that a lot of people use, giving them permission. I do get to worry, but I'm going to make it much more manageable. So it's not, again, taking over my day. So That's another thing you can do. You also want to use cognitive restructuring, right? So that's where, going back to the thought record as well, is you want to challenge your what-if thoughts. So anxious people have what-if thoughts. What if this What if this happens? What if that happens? What if this doesn't happen? And I'm always like, I don't know.

That's why you're anxious, because there's no answer to what ifs, right? We have to wait and see. So instead of saying, what if everything goes wrong, Instead, you can say, how am I going to handle that? What am I going to do? What is it that I think is going to go wrong? And obviously, it's going to be a hot thought if it says, what if everything goes wrong? I mean, that's huge. No wonder you feel overwhelmed. Everything goes wrong. That's big. I would ask my client, What do you mean by everything? And let's break that down and say, How would you handle this? How would you handle that? What are your other thoughts that are underlying Why you even think everything's going to go wrong? What evidence do you have with that? So you want to catch yourself with your what if, right? And I tell people, too, when you're doing your thought record, if your hot thoughts or questions, like What if everything goes wrong? Again, you can't challenge questions, so you want to turn it into a statement. So what you're telling yourself is everything will go wrong, and that's a hot thought.

So usually, 98% of the time, you can turn your hot thoughts that are in question form into a statement, and then you can challenge that. So you want to replace the, again, what ifs with making it a statement. And then you can also identify some hot thoughts by saying, What's the worst case scenario? Because that's another cognitive distortion. People are all or nothing. A lot of people say, Oh, yeah, I just would think of the worst thing. I think of the worst thing all the... As soon as something comes up and it's like, that's really good thought record to do. Worst case scenarios have happened in life, of course. But even if they do, how can I handle that? How can I manage that? Recently, I've heard a lot of people talking about, and I've been doing this myself, that here in the United States, a lot of changes are happening, and people are nervous about what things will look like going forward. And so I just say, You know what? If I need to worry about something, when it happens, I will. But right now I'm going to just stay present and I'm going to let things play out and see what happens.

I don't want to get myself all caught up and upset and then be like, Well, that didn't happen. I was so upset and I used up all this time of my life, of my a day and nothing actually happened. So bad things do happen. Things happen that we worry about. I'm not saying they don't, but don't assume something's going to happen and be upset about it. When it happens, you'll have plenty of time to worry and to come up with a plan and figure out how to handle it. But the more present you can be and not doing the what if thoughts will help you. I've known some people that are pregnant. They're worried about when they go into labor. That can be a scary thought. What if this happens? What if that? What if I can't handle the pain? Let's just focus on right now. Enjoy the journey. Talk to your doctor, come up with a plan. That's what I'm saying. There's so much you have control over and that's what you want to focus on. People that are anxious focus on what they don't you have control over, and I want you to focus on what you do have control over.

That will help you be present as well. Another really great tool, especially focusing the future, is building a safety net for yourself. So you want to identify and you want to strengthen your support systems, whether that's friends or family. Again, professional help, having a therapist. You don't want to feel isolated regarding your future challenges. So these are the steps I'm going to take. I'm going to go forward in my future, I'm still a little nervous. So who can I talk to about this? What are some professionals, whether it's a therapist or maybe a professional in my field, like a mentor? I want to set that up so I have someone to go to and say, Am I handling this right? Have you experienced this? So building a safety net is excellent so you don't feel alone. That's an important thing in life in general, but that's a really great thing regarding going into your future. And something else, and one of my clients really found this helpful, is we talked about celebrating small wins You want to recognize your progress, even if it's minor. I tell everybody, progress, not perfection. This will build your confidence in your ability to handle what's ahead.

A lot of people pooh-pooh little things like, Well, yeah. Well, I had to. Well, da, da, da. But when this happens, right? I'm like, No, no, no. We need to look, especially when you have anxiety, at your past as building blocks. You know what? I handled that. I can handle this. I remember when that happened, I actually made good decisions and it worked out fine. Or I went to my support system and they helped me walk through it. Progress, progress, progress. And I know you guys can find things where you have made progress. All right? And again, even if it's minor in your eyes, it's something. It's just like, what would you tell somebody else? It said, Oh, I'm wanting to run a 5K. I'm only running a mile right now. I mean, would you just say, Well, you're never going to get there, then you're a loser. No. You're going to say, Hey, you got a mile down. Keep working, and you're going to get to your 5K. That's progress. It's more than me. I'm not running a mile. What would you say to someone else? You help other people recognize their progress, even if it seems small, and you encourage them to get to where they need to be or want to be, again, you can do that for yourself.

If you're having a hard time, if you're really self-critical, talk to that support system that safety net and say, I'm really having a hard time identifying some of my progress, and I know it's important for me to celebrate my wins. What do you see? Usually, people can give you 10 things. When I work with my clients, we're working on changing, say, a core belief, they might be able to come up with one or two when we get started, and I'm like, I can give you 10 right now. It's easier when someone outside of yourself can give you and see you for who you are versus you seeing yourself. So it's okay to reach out to get some feedback on that. But when anything happens, you say, You know what? That was a win. That was a win. That was a win. That feels good. Because then we're not focusing on what we didn't do or what we haven't done, but we're focusing on what we did do. And whatever we did is a win. Listening to my podcast and learning something new, that's a win. When you're done listening to this and you go out and try something different, that's a win.

Creating a bigger safety net, that's a win. Changing your thoughts, having more balanced thinking, doing something scary your thoughts, having more balanced thinking, doing something scary your thoughts, having more balanced thinking, doing something scary. I mean, there's wins. Sometimes getting up and on a bed and getting dressed is a win. It's not like, I should do that. Everybody does that. I don't know if everybody... Not everybody's doing that. That's the thing. If you're making progress, it is a win. And I want you to give yourself that win. Maybe even have something on your phone or a pad of paper that you put a little mark every time you have a win. And at the end of the day, you can see how many you have because I'm sure you have more than you're keeping track in your head. So these are all really great tools to be able to start facing people and focusing on your future without letting this crippling anxiety take over. So something, maybe an affirmation you can use regarding your future as You can say something like, I don't need to know the whole future. I only need to focus on today.

That is true. Another one you can... And these are balanced thoughts as well, or alternative thoughts, which is part the thought record. Another good one would be, I can learn to trust myself to handle challenges. That one feels good to me. I can learn to trust myself to handle challenges. And I don't need to know the whole future. I only need to focus on today. Those are just some quick new thoughts. If those work for you, write them down, do a thought record, create more on your own that you really want your new thoughts to resonate with you. You want to believe them. The more you believe them, the more they're going to work for you. So I hope this was helpful. There's lots more tools for anxiety with CBT, but these are some good ones. Again, I thought it can't hurt to review anxiety because everybody's got a little bit of it, and it comes up in all different ways in different times and unexpectedly, right? Unexpectedly.

So as always, I appreciate you being here with me. Please share this podcast with anyone who you think may benefit from it.

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