Editor’s Note: This is the second of a three-part Q&A with Lynne Henderson, PhD, author of Helping Your Shy and Socially Anxious Client: A Social Fitness Training Protocol Using CBT
In your book, you present your social fitness model for treating shyness and social anxiety. What are some of the key differentiating factors between this social fitness model and the previously used models for treating shyness and social anxiety?
The key differentiating factors between the social fitness model and other models of working with shyness and social anxiety is the focus on health rather than pathology or disease. Social Fitness is a health maintenance model. Because shy people are ready to believe that their innate sensitivity to others, which can be a gift, means there is something wrong with them, they are vulnerable to seeing themselves as sick. Instead, what they learn to do, just like athletes and actors, is to perform when they are scared, when their adrenaline is pumping. In the process they learn to use the heightened arousal to help hone their social skills as they practice. They learn to view shame and resentment as simply being normal human emotions and social avoidance as being out of shape. They can work on changing their beliefs and perceptions of themselves and others and to accept that these kinds of feelings are part of being alive, shared with all human beings; and they can deliberately test their hypotheses that people won’t like them or approve of them using behavioral experiments.
The deliberate and increased focus on specifically changing negative attributions and negative beliefs about the self and others is also a differentiator. These are embedded in cognitive restructuring, but emphasized in social fitness training, with specific questions for challenging them.
Focusing on social skills and deepening intimacy in the second 13 weeks of treatment is also a differentiator, in that clients participate in dyadic exposures to intimacy, from self disclosure and trust building to handling conflict, expressing positive and negative emotions, and practicing assertive behavior.
Another differentiator is integrating compassion-focused therapy into social fitness training, with mindfulness and imagery techniques to help develop compassion for oneself and others. I added compassion-focused therapy to the social fitness model in order to help clients understand the universality of the social threat system, which is built in through evolution, and the negative human emotions that result, such as shame and anger as well as fear. Understanding that our brains are tricky, not our fault, and lead us to overreact and overestimate negative evaluation is understandable, and we can help ourselves, not only through working with our thoughts and compassionately accepting our emotions, but learning to better soothe ourselves and each other when things are stressful and challenging.
There are four domains of Social Fitness Training that form the framework of objectives in work with clients being treated for shyness and social anxiety disorder. What are these four domains and can you give a brief description of each?
The four domains of Social Fitness Training are: working with physiological arousal, behavior, thoughts, and emotions. Clients begin work with their physiological arousal by first role-playing challenging situations in the moderate range of fear and then practicing their new behaviors in real situations in their lives. Next they role-play and practice more challenging situations in a graduated manner until they are role-playing and practicing their most threatening situations. In this way clients learn that they can handle their arousal just as athletes do.
They can actually use their adrenaline to hone their performance and their mental acuity as they practice. While they tolerate and use their adrenaline as they practice new behaviors in their feared situations, simultaneously their physiological arousal is also gradually reduced with practice.
Clients reduce their avoidance and change their behavior by initiating conversations, contributing in meetings, asking questions in classes, asking people to do things with them, and asking for dates. They also practice asserting themselves by asking for what they want or need and saying no when it is appropriate.
Clients change negative thinking patterns by identifying their negative automatic thoughts and then categorizing them into the appropriate cognitive distortion categories, such as mind reading and catastrophizing. They then challenge the negative thoughts with Socratic questioning and develop more supportive encouraging things they can say to themselves before, during, and after social interactions. Some clients prefer to use techniques from acceptance and commitment therapy (ACT), which involve simply letting their negative thoughts be voices on the bus they are driving. As the bus driver they just allow the voices to be there, and don’t counter or struggle with them. However they are not pulled off track by the voices because clients continue to drive their buses in the direction they want to go, according to their own values.
Clients also practice compassionate self-talk using compassion-focused therapy, and use compassionate self-correction instead of berating themselves for less than perfect behavior, imagining a kindly teacher who focuses on their strengths and builds on them. These exercises are highly consistent with social fitness training, which is also a strengths-based model. We all work with our strengths and develop them, with coaches helping us identify our natural social talents just as they would our athletic ones, and then we build them further.
We work with emotions in social fitness training by practicing identifying the emotions we are experiencing and then practicing verbal and non-verbal expressions of emotions. Because non-verbal expression of emotion accounts for the bulk of emotional communication, clients learn to communicate warmth through smiling, open postures, nodding when listening, maintaining eye contact, and leaning toward the person who is speaking. Because our faces freeze a bit when we get nervous, people can think that we are unfriendly or snobbish. When clients understand this it makes it easier to practice friendly non-verbal behavior. There is a great card game where each card represents a particular emotion. As each person draws a card from the deck, they communicate the emotion the card represents non-verbally. The rest of the group members guess the emotion. All of these exercises can be found in the book with references.
Verbal expression of feelings is also practiced through exercises where each emotion, such as anger or fear, is expressed verbally in ways that help others to hear. Instead of saying “I am furious with you!” clients might learn to say “I am feeling anger right now. I think it was triggered when you said I needed to speak up and talk louder. I am working on doing that and I want to speak up more often and make myself heard. I also appreciate that you want to help me change that behavior, but when you said it as a command or a ‘should,’ I got defensive. Would it be possible to ask me to speak louder so that you can hear me better? That way, I will be happy to do something that will make things easier for you and better for me at the same time.”