Social Anxiety Disorder (Social Phobia)
Advanced Therapeutic Solutions for Anxiety provides exposure therapy for the treatment of Social Anxiety Disorder.
Social Anxiety Disorder (Social Phobia) is a persistent and consistent fear of negative evaluation from others. To minimize the fear, individuals with social anxiety will avoid being in a situation where scrutiny from others is possible, for example calling in sick to avoid giving a presentation, avoiding social gatherings, or turning down employment opportunities because it requires presenting in meetings. Feared outcomes include saying something wrong or offensive, acting in a way that will feel humiliating, showing anxiety symptoms (e.g., blushing, sweating, trembling, stumbling over words) which will be perceived as weak, crazy, dumb, unlikeable, etc. If the situation cannot be avoided, then it is endured with intense anxiety, sometimes even leading to an anxiety attack or panic attack, creating more embarrassment, and deepening the fear. In children, fears include:
- Social interactions (e.g., going to parties, talking to peers, talking to unfamiliar people)
- Being observed (e.g., eating or drinking in front of others; writing in front of others)
- Urinating in school or other public bathrooms when others are present (“shy bladder syndrome”)
- Performing in front of others (e.g, giving a speech or presentation, performing in school programs)
Children and teens may show anticipatory anxiety, such as worrying weeks in advance, but daily, about presenting a school project, with fear and anxiety increasing as the deadline approaches. The fear is out of proportion, and may include crying, tantrums, freezing, clinging, or shrinking in the social situation.
People with social anxiety learn ways to reduce their anxiety, such as seeking reassurance from others, over-preparing for a task, bringing along a comfort item, but oftentimes, these strategies are short-lived because they interfere with learning, feed the anxious-avoidance loop, and make their fear of negative judgment worse.
Social anxiety is not due to a lack of social skills; in fact, many people with social anxiety have in-tact social skills, but they underestimate their ability while overestimating others' negative judgments, creating more anxiety that interferes with functioning and feeds negative core beliefs (e.g., "I'm a bad person"), which is what needs to be targeted in therapy. The @introvertdoodles.com comic on this page is a great example.
Treatment for social anxiety involves cognitive behavioral therapy (CBT) to identify the negative core beliefs, identify the predictions of fearful outcomes, behavioral experiments to test core beliefs and gather new data, and learning what safety behaviors pop up while engaging in the behavioral experiment. Therefore, treatment involves exposure therapy to extinguish the fear, coupled with cognitive behavioral therapy and acceptance and commitment therapy to identify negative core beliefs and focus on healthy/balanced beliefs.
Clinical Procedures for Social Anxiety Disorder (Social Phobia) Evaluation and Outpatient Treatment
Free Phone Intake Consultation
Up to 30-min phone consultation so we can hear about your presenting issue, the symptoms you are experiencing, when they started, the severity of symptoms, and if we are the appropriate place for your treatment. The diagnostic intake process is discussed, and your insurance/billing questions are answered. If the treatment you need is within our scope of services, we begin the scheduling process. If it is deemed that we are not the appropriate place, we will provide you with referrals and resources to help you. We want to make sure to connect you with services, and that includes helping you find treatment elsewhere if that's what you need.
CPT CODE: 0
A 90-min diagnostic intake interview with the child’s parents to assess symptoms, collect history, review systems (school, home, community), differential diagnosis, review of prior records, review parents’ families psychiatric histories, and follow up/clarify any questions that arose from reviewing the questionnaires parents/child/teen filled out before the intake session.
Starting at 295
CPT CODE: 90791
Child Observation and Intervention
Up to 60-min live behavioral observation(s) to assess and quantify the degree of anxiety, allowing us to define a baseline. Using a play-based model, additional questionnaires may be filled out for diagnostic purposes. Interventions are tested out, also using a play-based model, to assess the child's response to intervention for treatment planning purposes.
Starting at 195
CPT CODE: 90837
Parent Feedback Session, Guidance, and Treatment Planning
A 1-hour feedback session with parents is held which includes presenting diagnoses, symptom severity, diagnostic rule outs, and discussing the recommended treatment plan. Parents are asked for their specific goals for their child and what they hope to gain from treatment at ATSA. Decisions are made as to whether the child will start with therapy sessions only, allowing for the future addition of psychopharmacological treatment as an adjunct, or whether to start with combined treatment (or in rare cases to start with psychopharmacological treatment before CBT). Parents will be provided guidance on the behavioral techniques to implement at home and in the community with their child, to help maintain and generalize treatment gains. Parents are provided feedback about their child’s behavioral challenges and gains from the initial assessment sessions, and the specific techniques that will be used to successfully help their child overcome his/her specific barriers in the exposure process. Throughout treatment, parents are provided with additional feedback sessions to discuss next steps, including help with transfer of skills outside of the clinic setting.
Starting at 195
CPT CODE: 90846
Child Exposure Therapy Clinic Session
60 min exposure sessions to present the child with the phobic stimulus and begin the process of fear extinction. The key to exposure therapy is to activate new learning, which is done by presenting the child with the phobic stimulus, and assisting the child to approach (vs avoid) the stimulus. Parents are also taught how to facilitate approach coping and reduce enabling avoidance. Your therapist will use modeling, shaping, corrective feedback, and contingent reinforcement with child and parents. Our data show that when parents are involved in treatment, gains are more likely to transfer into the home and community settings.
Starting at 175
CPT CODE: 90837
Child Exposure Therapy in School, Community, or Home Settings
60-min exposure sessions provided in the school, home, or community setting to help transfer treatment gains into these domains. To increase transfer of treatment gains, reduce avoidance of the phobia across settings, and reduce others rescuing the child from approaching the phobia (to rescue them from distress), in-vivo and in-situ exposure therapy is most effective. Not only does the child develop distress tolerance, new learning, and fear extinction, so do the adults in these settings, which helps them reduce rescuing and enabling. We will train school staff on how to appropriately prompt, monitor, and reinforce your child’s approach behavior with guidance via modeling and demonstrating use of skills. Home visits are used to help child and parents use skills at home, and Community sessions provide exposure practice in new settings.
Starting at 185 + travel
CPT CODE: 90837