Mindfulness-based cognitive therapy (MBCT) incorporates elements of cognitive-behavioural therapy with mindfulness-based stress reduction into an 8-session group program. Initially conceived as an intervention for relapse prevention in people with recurrent depression, it has since been applied to various psychiatric conditions.

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1. Mindfulness is a fundamental skill taught in Dialectical Behavior Therapy (DBT) that aims to reduce automatic thoughts patterns that lead to harmful behaviors. According to Ryan and Deci (2000), mindfulness may be imperative in disengaging individuals.
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Upsetting Social Anxiety Thoughts

–I don’t know what to say. What do I say next?

–I might say something stupid / offensive.

–S/he’ll think I’m boring / stupid / unattractive / socially inept, and will dislike me.

–What I have to say isn’t good enough. No one will be interested.

–They can tell I’m anxious and will think I’m weird or weak.

–I might embarrass myself.

These are just a few of the many distressing and distracting hot thoughtsthat make us feel socially anxious. If only we could silence them!

If only. Have you ever tried to push an annoying thought out of your mind? Typically that effort backfires and ends up strengthening and prolonging the thought. Try this experiment: tell yourself that you must stop thinking about a pink elephant. Or, when you have a melody in your mind, try very hard to stop thinking about that tune. Most people find that trying to stop thinking about a thought paradoxically leads us to think about it even more! That’s because our efforts to stop thoughts are really telling our brains that these thoughts are very important.

What is Mindfulness for Social Anxiety?

Cognitive-behavioral therapy (CBT) teaches that it is more helpful to train our brains to treat these hot thoughts as unrealistic and unhelpful than it is to try to get rid of them. One strategy to do this is called MINDFULNESS: paying attention to the present moment with interest, rather than judgment.

I have the impression that most people think mindfulness means meditation. Even many therapists who teach mindfulness training are really just teaching meditation. That’s especially unfortunate because meditation, despite it’s many benefits for other concerns (eg. stress management, pain management, spiritual development), has been demonstrated to be a very ineffective strategy to overcome social anxiety. Meditation is certainly one place to practice mindfulness. But for dealing with social anxiety, it is much more useful to practice mindful focus during conversations and other situations around people in which we are uncomfortable.

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Curiosity Training: Practicing Mindfulness for Social Anxiety

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I call this type of mindfulness practice while we are interacting with others—or even while we are simply around others—curiosity training. We are learning to get out of our heads and into the moment. Instead of focusing our attention on ourselves—criticizing our performance or appearance, trying to guess what others are thinking of us, struggling to script out what to say—we learn to treat all those thoughts asbackground noise—something we’re aware of but not paying attention to—and instead return our attention to taking interest in the situation, the person, and the conversation.

We’re not trying to stop or silence any distressing thoughts. Remember, doing so tends to backfire and strengthen the thoughts and increase our distraction. We are instead learning to gently put those thoughts into the background—like we do with noise—and refocus our attention on taking interest in what is happening outside of ourselves. Some people find it helpful to silently say something very short and non-critical—eg. “mindful,” “present,” “focus”—to briefly interrupt our thoughts and then refocus our attention on the conversation, persons or situation in the moment.

Curiosity training takes frequent, ideally daily practice. It’s easiest to start practicing in situations in which you are calm, and working your way up to more anxiety-provoking situations as you get better at it. An additional tool that some people find helpful in learning mindful focus when anxious is the Attention Training Technique, a 10-minute recording created by Adrian Wells, PhD, in which you practice focusing on one sound while putting several other sounds into the background. (Email me and I’ll send you a copy: larrycohen@socialanxietyhelp.com.)

Cognitive Restructuring for Social Anxiety

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But what if my hot thoughts are too distressing to treat like background noise? Worse yet, what if they are true, or at least partly true? I can’t just ignore them then, can I? Fortunately, there is another strategy used by cognitive-behavioral therapy (CBT) to deal with distressing thoughts called COGNITIVE RESTRUCTURING. In contrast to mindfulness, which helps us change our relationship with our thoughts, cognitive restructuring helps us learn how to test our thoughts against real world evidence, and change their content so that they are more realistic and helpful. I will describe how to do cognitive restructuring in my next blog post. In the mean time, I suggest reading Mind Over Mood by NSAC Newport Beach / Orange County director, Dennis Greenberger, PhD, for an excellent description of how to do cognitive restructuring to help with anxiety and depression.

Larry Cohen, LICSW

Cofounder, National Social Anxiety Center; Director, NSAC District of Columbia

larrycohen@socialanxietyhelp.com; 202-244-0903

How to Get Help for Social Anxiety

The National Social Anxiety Center is a national association of regional clinics with certified cognitive therapists specializing in social anxiety and anxiety-related problems. We have compassionate therapists who can help you to reduce social anxiety. Currently, we have regional clinics in San Francisco, District of Columbia, Los Angeles, Pittsburgh, New York City, Chicago, Newport Beach / Orange County, Houston / Sugar Land, St. Louis, Phoenix, South Florida, Silicon Valley, Dallas, Des Moines, San Diego, Baltimore, Louisville and Philadelphia. Contact our national headquarters at (202) 656-8566 or visit our Regional Clinics contact page to find help in your local area.

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