Case study. social anxiety disorder

We present the case of 'Sofia,' a 23-year-old woman who experiences intense anxiety in most social situations, especially those that involve interacting with new people or being the center of attention.

She fears being judged negatively, making a fool of herself, or that others will notice her anxiety (blushing, trembling).

This has led her to avoid many social and work opportunities.

Assessment and Case Conceptualization

Sofia describes a marked fear of negative evaluation, automatic thoughts such as "They're going to think I'm stupid," "I'm sure I'll blush and everyone will notice," and "I won't have anything interesting to say."

She avoids parties and presentations, and limits her interactions to a very small circle of friends.

Her social anxiety significantly interferes with her desire to advance professionally and have a richer social life.

Her fears are identified as being maintained by beliefs underlying beliefs about her own self-worth and the presumed criticality of others, as well as avoidance and the use of safety behaviors (such as excessively rehearsing what she is going to say or avoiding eye contact).

CBT-Based Treatment Plan

Treatment for Sofia would focus on:

• Psychoeducation: About social anxiety, the cognitive-behavioral model, and how her thoughts, fears, and avoidance behaviors interact to maintain the problem.

• Cognitive Restructuring: Identifying her negative automatic thoughts in social situations, analyzing the evidence for and against them, and developing more realistic and adaptive alternative thoughts. Work would be done on challenging her beliefs about the likelihood and consequences of being judged negatively.

• Social Skills and Assertiveness Training: Although Sophie may have some skills, anxiety can interfere with their execution. Skills such as starting and maintaining conversations, expressing opinions, making requests, and handling criticism assertively would be practiced, using techniques such as modeling and role-playing.

• Gradual In-Live Exposure: Develop a hierarchy of feared social situations (from greeting a neighbor to making small talk) and progressively confront them. During the exposure, work would be done on eliminating safety behaviors and testing her negative predictions. For example