Written by: Shalyn Isaacs / Communication Coaching / November 19, 2021 / 10 minutes read

I define communication anxiety as physiological responses to social situations that are perceived as a threat by our nervous systems – for example, one with communication anxiety may experience a racing heartbeat, digestion difficulties, trouble sleeping, headaches, etc when confronted with certain social situations. I define communication avoidance as the psychological and physical responses people often unconsciously engage in to cope with communication anxiety – for example, directly avoiding interacting with certain people or social situations because they trigger anxiety. 

Considering the perspectives of the Cognitive approach to understanding the psychological tendencies of those who experience communication anxiety or avoidance, my question is: how can Cognitive Behavioural Therapy (also known as CBT) be used to help these individuals challenge, reframe, or alter the core and conditional beliefs they espouse to enhance their communication and relationships? What types of new core and conditional beliefs would need to be created and maintained and how would these beliefs impact the lives and behavior of those who struggle with communication anxiety and avoidance?

The cognitive approach to understanding avoidant personality dynamics focuses on the specific contents of cognition that overwhelm the information-processing apparatus which thereby leads to behaviors that reduce quality of life, self-esteem, satisfaction, achievement, and the potential for experiencing close social relationships. The contents of cognition among those diagnosed with anxiety or who demonstrate social avoidance consists of core and conditional beliefs that influence experiences of hypervigilance and extreme sensitivity to environmental stimuli so much so that most events and stimuli encountered are perceived as threatening and encourage the individual to flee the situation. Specific core and conditional beliefs which lead to this hypervigilance include: two core beliefs, two conditional beliefs, and three instrumental beliefs. 

Therefore, this 2-part blog post series will explore in depth the types of core beliefs and behavioral patterns that CBT has been used to treat and the methods used, as well as the ways that individuals who have communication anxiety or social avoidance have experienced positive or negative outcomes following treatment. Thus far, my research has shown how classes of CBT such as social skills training, cognitive reconstructing, exposure exercises and intimacy-focused skills training have improved symptomatic behaviors associated with communication anxiety or social avoidance.

Cognitive restructuring addresses the core and conditional beliefs that those with anxiety and social avoidance tend to have which negatively affect their behaviors in social situations. It involves patients examining their thought patterns surrounding feared situations and the internal beliefs that may be causing such fearful reactions to certain social stimuli. The process of cognitive reconstructing includes: 1) identifying thoughts that occur before, during, and after situations that elicit a fearful response, 2) assess the validity of these beliefs through Socratic questioning and 3) construct more adaptive thoughts based on the information derived. Exposure exercises derived from CBT involve the patient and therapist constructing a list of anxiety-provoking situations and having the patient engage in the feared situations from the least to most anxiety provoking ones through using imagination, role play, or actual confrontation of the situation outside of therapy. Lastly, social skills training involves “therapist modeling, behavioral rehearsal, corrective feedback, social reinforcement, and homework assignments” (Heimberg, 2002).

This 2-part blog series will analyze how each of these classes of CBT have supported the alteration of core and conditional beliefs and symptomatic behaviors among those with communication anxiety and social avoidance and assess future directions for treating these issues from a cognitive approach.

In an article by Matusiewicz, Hopwood, Banducci and Lujuwez (2010), the benefits of Group Cognitive Behavior Therapy in the treatment of social avoidance because this treatment targets specific issues that tend to complicate the lives of those who struggle with avoidant personality behaviours, such as interpersonal and relationship difficulties and avoidance of stimuli perceived to be threatening and overwhelming. GCBP is a multi-component treatment consisting of gradual exposure exercises, cognitive restructuring (encouraging patients to participate in exposure exercises) and social skills training. 

Stravynski and colleagues found in their study that multi-component treatment does not produce superior outcomes in patient diagnosed with social anxiety or avoidance disorders. Results showed that although participants undergoing both treatments showed significant improvement in symptoms of depression, social isolation, anxiety and maladaptive beliefs, the ‘cognitive restructuring’ component of treatment did not seem to improve outcomes beyond the way symptoms improved with exposure and skills training. The problem I find with this particular source is the ambiguity surrounding the meaning of “cognitive restructuring.” 

In next week’s blog post, we will explore more of the scholarly research around how CBT and cognitive restructuring can impact the lives of those who demonstrate communication anxiety or social avoidance tendencies.

REFERENCES

Matusiewicz,, A., Hopwood, C., Banducci, A., & Lujuwez, C. (2010). The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. The Psychiatric Clinics of North America ,33(3), 657-685. doi:10.1016/j.psc.2010.04.007

Stravynski, A., Belisle, M., Marcouiller, M., Lavallée, Y., & Eue, R. (1994). The Treatment of Avoidant Personality Disorder by Social Skills Training in the Clinic or in Real-Life Settings. The Canadian Journal of Psychiatry,39(8), 377-383. doi:10.1177/070674379403900805

To work with Shalyn Isaacs as your psychotherapist (qualifying) at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or by calling (647) 795-5277.