CBT Tools for Social Anxiety: Self-Talk, Exposure and Shame-Attacking

Social anxiety can trap clients in a cycle of self-doubt, physical tension, and avoidance. But with the right tools—and clear guidance—you can help them break through.

This live, practical training will show you exactly how to apply powerful CBT strategies for lasting change—tools you can use immediately in your own sessions.

You’ll Learn How to:

• Interrupt the Cycle of Social Anxiety
  Understand how self-talk, somatic symptoms, and avoidance interact—and how to target each layer
   

• Use Effective Exposure Techniques
  Learn practical interventions like Smile & Hello, Shame-Attacking, and in-session role plays that help clients face social fears head-on
   

• Build Buy-In for Exposure Therapy
  Help clients understand the value of facing fears and how to stay motivated—even when discomfort arises
   

• Use Select TEAM-CBT Tools That Get Results
  Learn focused methods from the TEAM-CBT model that bring clarity, structure, and real results to your therapy process
   

IN THIS VIDEO:

Angela Krumm: Welcome everyone. We are just allowing the last few people to be admitted and we will get started in just a moment. Great to have you all here, welcome. We are so happy to be presenting to you today on CBT tools for rapid recovery from social anxiety. It is a treat to have all these folks joining us from all around the world today. We have a lot to try to cover in the hour. We are hoping you will leave today with some practical methods in hand that you can use to treat social anxiety. And of course we hope that you will learn with information about how you can learn more given that we can only cover a little bit of this great content today. I am Angela Krumm. I am a co-founder here at Feeling Good Institute and our director of professional development. And I love treating social anxiety disorder. I would say it is the one thing that if I could fill my caseload with, I would be most pleased with. I also love training other therapists in how to really transform their practice from just talk or support into really having effective methods to help people make lasting changes. I am so happy today to have two co-presenters. The first, Shiveta Gandotra, who I especially feel grateful for today as she just flew in last night from a trip to India and is recovering from the time zone change. So kudos to her. Shiveta, in addition to being a level three TEAM-CBT trainer, a really skilled clinician, is a former university professor. So she comes to us with both academic and clinical knowledge. She works here in our Mountain View California office and also virtually throughout California. She works with adults, children, couples, teens. So she runs the gamut and treats all kinds of things including anxiety, depression, substance use problems, attention concerns, and the like. Our third presenter, LJ Davis, is in Georgia and is a level four TEAM-CBT trainer. LJ has over 15 years of experience working with concerns such as depression, anxiety, also things like insomnia and relationship struggles. He brings both clinical expertise and lived experience having personally navigated social anxiety. He now likes helping clients overcome the same. LJ also is a teacher in our fast track to level three deliver practice group. So many of you might be familiar with him or get opportunities to work with him in the future. So some of you who are here today, there are our presenters.

Some of you who are here today are familiar with Feeling Good Institute. Some of you might be brand new and we welcome you to our community. FGI has a mission to elevate the practice of therapy so that patients can recover faster and really more fully or more completely. We train and certify therapists in an approach called TEAM-CBT which is a powerful framework developed by David Burns. And we do this through a structured five-level certification program that we are pretty excited about. We were founded by Maor Katz, Jill Levitt, and myself. We all met through trainings from David Burns at Stanford years ago. Back then really the only way to learn TEAM-CBT was to work directly with David and practice with him. And to be honest, it took years to learn the methods. We wanted to spread these methods further and increase client access. And so we started FGI with this really big dream. That was to make David's tools, his techniques and even his approach to teaching more effective. And to, I am sorry, not to make it more effective, but to spread it more widely and to not compromise quality in that process. So everything we do today still reflects that original intention of helping therapists get better so that patients can get better too. At FGI we do not just teach people technique. Instead, we replicate this training style that I mentioned that Dr. Burns showed us and that we have learned more about through deliberate practice literature. It is really this foundational idea that you can only get better with practice and feedback and repetition. And it might be surprising and even discouraging for people to hear that experience alone does not always increase therapist outcomes. So just doing more sessions does not necessarily mean that you are getting better. What we know does work is learning, practicing, getting feedback and then repeating that cycle so that we can really emphasize the learning and make sure that we are consolidating that learning through practice. So we do that in all our trainings including the one that I will tell you more about a little bit today.

Now before we jump in, I have kind of a silly teaser question for you. And it is to ask yourself, do you want to become a better therapist? And more importantly, are you at a phase in life that you are willing to invest time and energy to do that? To train and practice so you can get there? I am guessing many of you will have the answer of yes because you are here today. And that shows that you want to grow and learn and improve. And that is what sets apart really, really good therapists who want to move forward. Later today I will give you a bit more detail about a program we have created to help therapists level up their skills really quickly. It used to take years of intensive training to learn these skills. And now we have created a highly structured training program that takes six months. I believe the course is really effective and the trainees that I supervise I require to take it because I have seen how it really quickly teaches them methods that can turn around therapy outcomes. So many of you are thinking ahead to getting your CE credit for today. You will be offered one CE credit. We will put at the end of the seminar in the chat box the reminder that you will need to do a mandatory survey. And when you complete that survey, it will initiate a process of giving you a certificate and take about a week. So be patient and look for your email. And again, we will prompt you with that at the end of the webinar. So nothing to worry about today or for now. Okay. So we have big hopes for our time together today but obviously we have to simplify to a couple primary learning objectives. So first we hope today you will leave with more ability to identify common negative thoughts that are characteristic of social anxiety. And second we really want you to be able to describe the purpose of exposure exercises overall. And at least take away one that you can start using right away. For example, shame attacking or some of the others which LJ Davis will teach you about later today. So towards these goals, we are going to talk about the cognitive model for treating social anxiety. Shiveta Gandotra will share more in that section and then LJ Davis and I will teach.

The exposure method and we will save a few minutes for your questions at the end. If you do have questions, you can submit them by chatting to Mike Christensen, who is our awesome host and our clinical director here at Feeling Good Institute. He will not be able to answer technical questions. If they are about content of the webinar, send them to him and he will choose a few that we will do our best to answer at the end. Okay, okay. So let us start with a brief walkthrough of what is this TEAM-CBT framework so that you can kind of follow along and understand where we are couching the interventions today. TEAM is an acronym, T E A M. It is a roadmap for how to do therapy. And the beauty of the model is that it is really flexible. And it is also transdiagnostic, which many of you know is a fancy way of saying it can work with a lot of different presenting problems or concerns. The framework helps you guide your sessions forward, not getting stuck in just talking or looping around to the same things over and over again, but really creating lasting change for clients. T is for Testing. We use brief, validated measures at the beginning and end of every session to track progress and also to elicit client feedback so that we can adjust and learn and grow. E is for Empathy. So of course, before trying to help someone, we have to focus on understanding the patient's experience. We use a specific format for doing empathy which was new to me when I learned this model and has been transformative. It is useful to build trust and safety but also to deal with ruptures or difficult communication moments. A is for Assessment of Resistance. So rather than assuming our clients are ready to change, we slow down at this phase to set specific goals and really identify and work through resistance or barriers to change. A hallmark part of this step that people who learn TEAM-CBT love is something that has been coined as positive reframing where we actually find the good in what may otherwise be labeled as negative or problematic symptoms. And finally, Methods where we will spend the most of our time teaching today. Once that readiness is established, we introduce various powerful techniques. And we feel grateful to have a very long list of options available.

That we teach our therapists. And we can offer the ones that are applicable to the specific client in front of us. The Method section is also where therapists are rather integrative and able to bring in methods that are useful that they have learned in other approaches. Okay, so just know that what we will cover today is just the tip of the iceberg. We cannot possibly teach you this whole model. If you find it interesting and want to learn the whole model then this fast track course that we have mentioned is the next best step. Okay, so social anxiety. It is one of the most common anxiety disorders in the US. The prevalence rates are somewhere between 7 to 12%. But what we know in the research and what most of us know in our clinical experience is that many more people will present with lesser degrees even if they do not meet full criteria. So actually this is something that most of us see in a large portion of our clients, way more than 7 to 12%. It is defined by a persistent fear of negative evaluation by others either in social or performance situations. And it is a heterogeneous condition. And what I mean by that is that it can present differently for different people. Some clients will experience it in very specific unique situations and others will experience social anxiety across almost every interaction where they are engaging with other people. So for example, some people have it more intensely in large groups. They will sometimes have a specific number. Once I get over four people, I feel really anxious. Others have the opposite. These small groups of one or two feel really scary to them. For some folks it is about similar aged peers. I hear a lot of adolescence and teenagers who say, "I really feel fine if I am talking to adults but man, if they are similar age peers." Other people it is around folks they are attracted to or people of power. And so you hear the heterogeneity of it and the importance of finding out the clients you are working with, what are the situations where it presents for them. What is common and shared across is this fear of being rejected, of appearing foolish or being the center of attention. So let us run a quick poll. My promise here is this is really common to feel anxious when socializing with others. And I would love to see from those of you in attendanc,e, to what degree do you feel anxious when socializing with others?

And Mike is going to get us started. If you have not done this before, you should see a poll popping up on your screen. And you just click an answer. And we will start seeing the results already. Cool. I love. Wow, look at all the people here today. That is exciting to see you all here and to see these numbers coming in. So so far it looks like our big winner is folks feeling a little bit anxious in some social situations. And so actually if I look at the bell curve here, more of you are less anxious than what I would expect in a typical population. But we definitely have some percentage of folks who feel extremely anxious and quite a bit anxious and then a little group of you, not at all. That is exciting to hear that some of you are not struggling with it at all. But what we can assume from this is that most of us at least experience a little bit, the vast majority or more. So thanks for putting that out. Okay. Wonderful. So given that we hope also today that some of you can find some helpful things in this for yourselves. Okay. So you might be wondering how is social anxiety developed and maintained? CBT, cognitive behavioral therapy, proposes that this happens through a self-reinforcing cycle including negative thoughts, physical symptoms, and avoidance behaviors. Negative thoughts such as, "I will embarrass myself" or "the stakes are quite high to impress these people." These can trigger anxiety before or during social situations. And then we see physical symptoms, commonly things like sweating, blushing. Oh, I am a total blusher. I turn red like that. A lot of you can probably relate to that. Or racing heart. Even before the presentation I said, "Oh, let me turn down the air conditioning. If I get nervous, I will get hot." So these physical symptoms can spin up the anxious thoughts and feed them. And there tends to be a high focus on these symptoms in folks who experience social anxiety. Avoidance behaviors are things like leaving early, being really quiet or avoiding socializing altogether. Not showing up. These provide short-term relief to people but they actually of course encourage the cycle because they prevent the person from learning that fears are either unfounded or that they can be tolerated.

And so the cycle keeps the anxiety going because the person is really denied the chance to change the negative beliefs or build new positive associations. Okay, so today we are going to talk about a case example of a young woman who I worked with over the last year, who I really have fond memories of and really enjoyed connecting with. Her name is Kia. I will give you a little introduction and then tell you a bit more about her. And I will ask you if you can spot these parts of the cycle in her story. So Kia had a long history of social anxiety. As long as she can remember, she describes that experience of being a small child who would kind of hiding behind her parents and her older siblings when they were around other people. Her anxiety led her to describe what she described as extreme people pleasing. And what that meant for Kia is that she was so nervous about getting it wrong or making a mistake that she would kind of never share her opinion, never put out her views about things because she was worried others might judge or dislike it. She tried to kind of fall in line with whatever she guessed others wanted of her. She started working with me after having gone away to college for the first year and coming back that first summer describing it as kind of a miserable year socially, a huge disappointment. She very much wanted to feel closer to people but felt kind of isolated and like she would show up but never really got to know people or felt included. She always felt a bit like the flower on the wall. So let us talk about, let me tell you a little bit more. And then I want you to again listen for examples of the negative thoughts, physical symptoms and avoidance behaviors that might be cycling for Kia. So before Kia would attend a social event, her thoughts would include things like, "I have to act perfectly for them to like me. They will reject me if I am not fun enough" or "I cannot do this as well as others." During socializing because she was very brave, and some people cannot even show up, she would go sometimes often she would go.

She would feel quite miserable though. And in one example she shared, she gave she said that she had been kind of pulled into a conversation where people were talking about their plans for the upcoming weekend. And she noticed her heart was racing. She was feeling heat throughout her body. And she was sure that her face was flushing red. She wondered even if she was visibly shaking. Then her anxious thoughts revved up saying things like, "Everyone is noticing how awkward and anxious I am. My weekend plans will sound so stupid because I do not have anything fun to do. And people must think I am such a loser. I have got to get out of here." Now of course her behavior started changing as a result of that self-talk. She reports she was giggling nervously, fidgeting. She ended up finding excuses to sneak off to the bathroom and eventually to leave early. And after the event, she would beat herself up. "That was a disaster. I am so awkward. I should avoid those people. I cannot possibly see them again in the future." And so hopefully you can spot how the thoughts, the avoidance behaviors and the physical symptoms are spinning together to reinforce the anxiety. So where do we begin to help someone like Kia? Well in the TEAM model, you will see this little icon in the top right corner that shows that we are talking about the T for Testing step right now. So with, we always start with symptom measurement and collecting that feedback that I mentioned before and after each session.

With social anxiety, we surely want to also gather specific details. So I told you a story about a conversation at a party. I would want you as a clinician to have a bunch of these detailed stories where you can hear exactly what is happening and spot those parts that are maintaining it. Third, we want to ask about what the client has learned from their culture and environment. So what are the social expectations in their various roles from family, among peers and academic or professional settings, in dating or romantic situations? So we want to find out how the expectations they learn from family and culture align or conflict with their personal values or goals for treatment. So for example, do they want to honor and maintain those expectations or are they in a place that they are actually wanting to move away from them and challenge them? And lastly, we want to assess whether things like bullying, discrimination or trauma may be the root of the anxious thoughts and the avoidance behaviors. So if Kia is withdrawing because the environment is unsafe then therapy might need to shift towards safety planning, advocacy or systemic support rather than reframing distorted thoughts and doing exposures. In Kia's case, that was not the case. But we want to be assessing for that and being thoughtful about it. Okay. So we will not be able to teach all of the E and A of the TEAM model today. We are going to assume in Kia's case that we had done great empathy and built safety. And that we had also assessed and melted away any resistance she would have to reducing her social anxiety by honoring the good parts of it and then also deciding how much she wants to change it going forward. And once those are complete, we are ready to move into the method section. So I am ready to hand it over to Shiveta who will talk with us about the cognitive model.

Shiveta Gandotra: Thank you so much Angela Krumm for this kind introduction. I am really glad to be here today and excited to share this presentation with you all. So talking about the cognitive model, which is kind of a psychological framework that explains how our thoughts, feelings and behaviors, they are interconnected. Our thoughts influence how we feel and how we act. And according to this model, when people experience distress, it is often not the situation itself causing it but rather their interpretation or perception of the situation. By identifying and challenging unhelpful or distorted thoughts, which is known as the cognitive distortions, individuals they can shift their emotions and behaviors in more positive directions. So talking about the cognitive work, it generally but not always precedes the exposure therapy. There are multiple steps that we cover with a client before starting exposure work for social anxiety. And in order to best help someone like Kia or any of our clients, we first need to be familiar with common types of negative thoughts experienced by individuals with social anxiety. So what are some of the examples of negative thoughts that you or your clients experience. Just enter your responses in the chat box to Mike and Mike, as the responses come in, will you please share some with us?

Mike Christensen: Excellent. Some are saying, "They are going to judge me." "I am not good enough." "I am screwed up." "They will think I am stupid." "I will be criticized." "Everybody hates me." "I am going to vomit." "I have nothing to say." "I am going to fail." "I will embarrass myself." Boy, they are coming fast and furious.

Shiveta Gandotra: Wonderful. Here, people they know about their negative thoughts. And they are so apt. And they are these and many others. They come in light when we work with the clients with social anxiety. Next slide please. Now let us take a look at some common negative thoughts that clients experience. While most people may have these thoughts from time to time, individuals with social anxiety disorder they tend to experience them more intensely and in a more debilitating way. "I do not have anything interesting to say." "If he does not respond, that means my text was stupid." "I am going to mess this up." "I might freeze up, forget, sweat, etc." "They can tell how nervous I feel." "I cannot control my anxiety." "They are probably bored talking to me." "I should not socialize because I am not good at it." "I made a fool of myself." "Everyone is watching me and judging everything I do." There are quite a few thoughts I can really relate to. I am actually having some of these negative thoughts right now as I am presenting. So how can we help clients who struggle with negative thoughts? While increasing the awareness of these thoughts, it is valuable first step and an opportunity to offer empathy. Which is not enough on its own. We also need to help clients learn how to respond to these thoughts in a more constructive way. In TEAM-CBT, one of the tools we use for this is the Daily Mood Log, which kind of guides clients in identifying, challenging and reframing their negative thoughts. The Daily Mood Log, it is a powerful tool which is used in TEAM-CBT, developed by Dr. David Burns to help clients identify, understand and challenge negative thoughts that leads to painful emotions. And using this tool, it helps set the stage for effective cognitive therapy. Some of you may have already used a different version of a thought record. And that is perfectly okay. If the Daily Mood Log is new to you, you can start by simply trying it on a piece of paper. And we will go over the basics together. The very first item number is we have to write down the specific moment at the top of the paper. Write a brief description of a specific situation that triggered a strong negative emotion. Just try to keep it concrete and recent. Second, use the first column to write down the unique negative thoughts. Write down the thoughts going through your mind during the event. These are your automatic thoughts, very brief, believable and often harsh. Third, use the second column to identify the cognitive distortions. Label each thought with relevant cognitive distortions such as all or nothing thinking, jumping to conclusion, mental filter. The fourth one, have the client write a rebuttal that challenges and corrects the negative thought. This means addressing the cognitive distortions directly and replacing it with a more balanced truthful perspective. The client should believe the new thought 100% and it must directly respond to the original negative thought. No superficial or overly positive statements. The goal is authenticity, not forced positivity. And the fifth one, the client will need to rehearse the new balanced thoughts repeatedly. The brain takes time to unlearn the negative thought patterns that may have been reinforced over many years. So consistent practice of these healthier thoughts is essential for lasting change. Next slide please. Now let us take an example using Kia. Using a case for Kia over here, the negative thought is, "They are going to reject me." This thought contains several cognitive distortions including all or nothing thinking, mental filter, jumping to conclusions. And a more helpful and balanced response might be, "People really fully reject or fully accept anyone. Most people like certain things and may dislike others and that is okay. I also have many positive qualities that I bring to social situations like being a good listener, making others feel good about themselves and being open to new experiences." You can learn more about how to use the Daily Mood Log, identify cognitive distortions and respond to negative thoughts in any of the Dr. David Burns books, self-help books such as Feeling Great. And you can also deepen your skills by attending our upcoming trainings and enrolling in the fast tack to Level 3 Advanced TEAM-CBT course. So this concludes the overview of the cognitive model. Now and I will hand it over to Angela who will walk us through the exposure model.

Angela Krumm: Thanks Shiveta that was a great overview and a good starter for folks who are new and good reminder for folks who have been using the cognitive approach. So clearly we believe in the cognitive approach. It is powerful. However, it is not always sufficient for anxiety. And the exposure model is where we invite clients to repeatedly face feared situations in a planned way to move past just talking back to their thoughts but actually start to face those fears. So there are important multiple steps to cover with a client prior to starting exposure work for social anxiety. So I will run through these four points briefly and then spend a bit more time on the next slides on the first two. So first of all, we do have to explain the rationale for exposure to clients so they can fully understand and buy in. And when I was really new to my therapy practice and exposure, I struggled with this a lot. I found it kind of clunky and I felt a little unclear myself. And so I just challenge you all who are new to doing exposure work to get clear on your rationale first. We will talk more about it in a moment because without the rationale being explained to the clients, we would expect low buy in and low follow-through if they do not kind of get it and see the importance. Second, we want to prepare ahead by brainstorming possible exposures. I think this is super fun to do. You can be creative and collaborate with your clients in doing it. Yesterday I actually used Chat GPT to help me come up with some more brainstorming because I was getting stuck with kind of a unique exposure situation and it was fun to add to my learning there. Third, we want to teach clients to banish avoidance and safety behaviors. So essentially, clients have to confront the fears and take away the things they are doing that are creating a false sense of safety. And those can go, those can be then incorporated into our exposures by having them do these harder things without the safety behaviors. Things like using alcohol or for in the case of a child like hiding behind their parents might be safety behaviors.

Lastly, we want to build an expectation of repeated practice. One round of exposure is rarely enough. Clients have to commit to this process of exposure becoming a lasting experience, almost a way of life and an attitude that they should implement. Okay, so let us talk a bit more about the rationale since I mentioned it is important. So there are actually various ways in which exposure can be really helpful. And if this is new to you, the site I will share on the resource site a treatment manual for social anxiety can be a really helpful way to supplement your psychoeducation. The first point here is that exposure can serve simply to actually identify new anxious thoughts that were missed. So if you have done the cognitive work that proposed, you might get out an exposure and they suddenly are clicking with new thoughts that they had not realized were there. And so it is an important part of just seeing what other cognitions might we have missed by putting them in the situation. Exposure can also serve to test the anxious thoughts. Is the predicted outcome real? Do people judge them harshly? Does something bad happen? Does the anxiety kill them and lead them to become a puddle on the floor? They have to test these things to find out. Exposure can also create new positive associations through inhibitory learning. So this type of learning occurs when new non-fear-based associations are generated with socializing. So another way to say that is clients can experience socializing has a different outcome than expected. For example, someone has a warm response to them on the street. Something like that. Point D here reminds us that exposure helps clients learn simply to tolerate anxiety and break down the idea that it is something intolerable and to be avoided. So by measuring anxiety throughout exposure using subjective units of distress or some other simple scale, clients can see how the anxiety ebbs and flows, goes up and down. Often anxiety comes down with exposure. But even if it does not, they are going to learn that they can tolerate those high points of anxiety and get through them. And my favorite way in which anxiety or exposure is helpful for social anxiety is that it can help build acceptance for social mistakes. I will put that in finger quotes. I am not sure if they are really mistakes or not but moments that the person feels awkward. So who agrees with me in this just a thought that socially awkward moments happen all the time?

And I thank you, LJ Davis agrees. I used to think I was supposed to avoid them and somehow prevent these from happening. But how enlightening when you realize that they are a normal part of socializing. Communication by nature is kind of awkward and clunky. And that when we stop avoiding them, we are really freed up. So exposure builds our tolerance for awkward moments so we are not crushed by them. Instead, we purposely create these social mishaps or awkward moments so that we learn that we can handle them and tolerate them. And we will talk more about a specific form of exposure exercises for that point called shame attacking in a little bit. So I also mentioned the fun of brainstorming exposure activities. This is just a quick brainstorm that will lead us into LJ teaching you about a couple of these methods in more detail. So some examples, I want you to always brainstorm things you can do in session with a client on video or in person. And things that you can do out of office with them or if you are not in a position to go with your clients for exposure out of office that they can do on their own out of session. So you always want to think of both options here, in session and out of session. And so in session often it is lots of role plays. It is a form of exposure. So things that are commonly hard for clients are how to start a new conversation with someone like how to initiate chitchat. How to end a conversation is really difficult for a lot of people. Even folks who feel kind of socially skilled wonder, "How do I wrap this up? How do I end this and move on?" And then of course, handling a social mishap. And your clients will tell you what social mishaps they are worried about. They will have a whole list of all the things that could go wrong and that they think are scary. And by roleplaying them, we are doing a form of exposure to confront those. Okay. Out of office exposures. Man, there are so many possibilities. Things like asking clients to just greet strangers, say hi, make eye contact or do self-disclosure. Chatting with strangers. And of course, anything that draws attention to the self. Things like public speaking or even just doing goofy things in public. So we will break these down more for you. So why do we, let us turn it over to LJ here who will talk to us about a couple of these cool activities.

LJ Davis: Right. Thank you Angela, I am excited to get to talk with everybody. And I was nervous beforehand. I am mostly feeling the excitement now though. I have been looking at the numbers down there. I see 640 people which means over 1,200 eyeballs are watching me right now or most of us. And that maybe brings the anxiety up a little bit to think of it that way. This first thing we are going to talk about is one, all of these are ones that I love. I really do like working with social anxiety. But Smile and Hello. It is just such a fun way to start doing some of the outside the office exposure. Though usually I will actually start this inside so I can think. I used to work on a college campus which is where I had a chance to do a lot of this. And with students then we would sit in my office to begin with and we would look each other in the eye and smile and say hello. And it feels pretty awkward to do that with somebody you have been talking to for a little while. It already like Angela was saying, gets us a little bit of exposure just there in the office doing that. And then we would leave the office and we would walk around campus. And most of the time I would greet the first person just kind of as a way of breaking the ice though that is not a hard and fast rule. And then we would go around and greet people and smile and say hello. And usually it started off scary and fun. And by the end it would actually be a lot of fun. And I would start doing silly things like greeting people who are across the road or things like that and sort of being bigger and more demonstrative. And so we can think of Smile and Hello really as an early step in a fear hierarchy for lots of people.

And it may help a few specific thoughts or beliefs that people have like, "People are not friendly" or "No one would want to talk to somebody like me" or "Socializing is too difficult" or "I could not handle it if somebody rejected me." And in essence, the technique is really there in the name. We are going to smile and say hello to people. But there are a few key things we want to make sure to do. Angela mentioned banishing avoidance earlier. And that is really what these next steps are about. So we want to attempt with everybody we pass by because if we do not, our clients or ourselves if we are doing it ourselves, will kind of subtly filter out people who we think maybe do not look friendly or do not look like they would be interested in somebody like me. So we do not want to let us have that kind of avoidance sneaking in. Similarly with making eye contact, it is a little bit less intense if I look at my feed or look off to the side. And so those are some subtle avoidances. Same thing with audible voice. We want to speak loudly so that people can hear. And then like I said, as we go, I will tend to start adding gestures. And so you know, again, maybe a big wave or something like that that makes it just a little more silly and goofy. And then an important thing I think with all of these is to help prep people a little bit for the outcomes. And the way I see it with Smile and Hello, there are kind of three main outcomes we can expect with each person. A sizable chunk of people will be friendly like they will smile and say hello back or they will just smile. Those sorts of things. And that is usually pretty easy for us to deal with. There is another chunk of people and I say this one is growing as people are getting more used to their phones and have their earbuds in, but there is another group of people who will not respond at all. They will not be mean. They will not be cheerful. They will just kind of keep walking. That may even be the majority nowadays. And it probably depending on where you live or where you are, that may be the majority. And then the third one is, there is the chance, I have not had this happen very much, that somebody could be, "What are you looking at?" Or you know, they could have some sort of grumpy response. And so just to be prepared for all those. And actually in my ideal world, when we would go out, I would try to make sure we talk to at least 10 people.

And if I could set it up, which of course I cannot, we would have at least one of each of those kinds of people so that our clients get the chance to experience that a rejection or a grumpy person does not really destroy them. And it is like, "Well, that, okay, let us go on to somebody else." And we can keep going. Let us go on to the next slide Angela. All right. And so self-disclosure is really based on the idea at least as an exposure technique is based on the idea that shame is one of the biggest parts of our social anxiety. That we have something we are feeling like we need to hide and that we are ashamed of. I actually got the opportunity to do some shame, sorry, some self-disclosure of my own a few years back. I have a tendency, like one of my little pitfalls, is that I think I should appear emotionally perfect. And so I should not feel afraid or sad or angry even. And so I got the assignment to go somewhere and say to people something like, "You know, my whole life I felt ashamed of a lot of my feelings. I felt like I should hide anger or fear or sadness. And I have decided to stop doing that. And that is why I am telling you about this today." And it was really a pretty amazing experience. One, just telling people that I do this like, I also felt ashamed of this pattern. And so disclosing that pattern to people was a huge thing for me. And the way people responded was also pretty amazing. I would never have guessed the kinds of responses I would get. The first person I talked to, I was probably very fortunate with this, was just like immediately open. And actually she gave me a hug and then she is like, "Wait a minute, I am not really a hugger." And we started talking and had just like one of the best connections I have ever had with somebody that quickly. And then I did have somebody at the end who his response was, "Well, why do you do that?" And so I did feel a little bit judged which helped me to have that experience and see that I could tolerate it. And then we talked some more and it turns out his partner has a similar pattern and he gets frustrated by it. And so in a way he was willing to understand but it still felt pretty judgy for me.

So that is kind of the power. And you can see if we think about Kia, one of her worries was that people could see that she was feeling anxious. And that they would reject her as a result. So self-disclosure can be a powerful way for her to face that fear by telling people she is feeling anxious. And we want to coach our clients to do that in a skillful way. And then she can let people know that she is shy. And she can find out if she is rejected or not. And then she gets to find out if she can tolerate that rejection. And she also probably finds out that most people will not reject her. Most of us can relate to feeling some sense of shyness. And it might also just be a powerful way of getting around some of the avoidance she does like trying to hide different things. And so that is also a powerful part of self-disclosure. And we will see the next slide please Angela some examples, here is a way that Kia might have gone and spoken to somebody. Again, could be on a college campus or at a social gathering of some sort. And you know she could just say, "Can I speak to you for a moment? I want you to know that ever since I was a kid, I have struggled with shyness. And I have also felt really ashamed. So I have been hiding it from everybody. But today I have decided that I am not going to be ashamed or hide it anymore. So instead, I am telling people that I am shy." And then you can see she also added a survey onto the end of it. "What are your thoughts about being shy? Is that something to be ashamed of?" And so you can imagine what kind of responses she would get to this sort of disclosure. And there are a few key points that I want to make about this as well. One, we also want to help Kia be prepared for the variety of outcomes that may come her way. And just be aware that this may happen. And that it is actually great if we get all these different sorts of reactions. That is the way I like to frame it that getting a rejection would actually be a great thing. I also encourage my clients and this is what I did too, to write it down on a note card or of course this being the 2020s, put it in your phone. And I do not want them to go and read it to the person they are talking to.

But when we get in that moment and we start feeling flooded, it is really easy to lose those words. And so having them somewhere where they can read them, go to the bathroom and read them or just like read them and remind themselves before they engage in the conversation, so they can really have the words fresh for them. I think it is also really important. And we can go on to the next slide for one other kind of self-disclosure. Angela did a little bit of this self-disclosure earlier where she mentioned that she blushes. And so people who are worried about their anxiety are also often worried that people can see it. And they can see that they are blushing. I know my hands shake sometimes. And sometimes I do worry about that a little bit. And so that is another thing that our clients can self-disclose instead of trying to pretend I am not blushing or trying to hide that I am blushing. I could just say, "You know, I do not know about you but sometimes I get really anxious at these events or it can be so awkward chitchatting. And I can tell I am blushing and shaking right now. Do you ever feel anxious or nervous at these events?" And so then like for me when I self-disclose things like this, there is just kind of a sense of freedom that comes to like, "Okay, I am done with trying to hide that." And that is a real gift that we can give our clients as well so they do not have to hide. And then they can move into hopefully feeling more relaxed or continuing to repeat the exposure and getting that benefit over time. So thank you so much. I will pass it back over to Angela who is going to take us into shame attacking. Angela unmute.

Angela Krumm: That is helpful, is not it? LJ has just given us a real gift as humans who, all of us probably struggle at times at least with the performance part of anxiety, this idea of self-disclosure. And I have taught folks at the Meta and Apple and the big companies, high-level folks who just now open presentations of this type of disclosure. And they find it so empowering to just say, "I care about this topic so much today that I will probably get kind of nervous and my voice might shake. I am glad I have my water if I get that dry mouth." And then they move on. And people seem to feel warm and supported from that self-disclosure. So thank you LJ I hope folks can experiment with that in their own life. I do want to talk to you about shame attacking because it is such a cool, powerful technique. So some of you may have heard of this through popularized media. There is something on social media commonly referred to as the comfort crusher movement. If you want to look that up for kind of real world examples of this. In the academic literature, this is referred to as social mishap exposure. So if you want to read the academic side, you are going to do searches for social mishap exposure. It is all kind of the same spirit of things that we refer to as shame attacking. So what is it? Well, it is going out in public and doing things that draw attention to the self and things that are kind of over the top, goofy, outrageous, purposely drawing attention to ourselves. And we, things like dancing on a straight corner, wearing clothes that your client might perceive as outrageous or attention getting, singing a song in public, riding a bus and reading aloud every street sign that you cross at the intersections. Really the options are endless. Why do we do this? Well, remember that most people spend their lives trying to avoid things that feel like awkward moments or social mishaps. And if we are too focused only on the cognitive therapy approach, therapists might even encourage this. They might be encouraging their clients to fight back with thoughts that say awkward things will happen with responses like, "Oh, it does not happen very often. I will do fine socially. I will not ever make a big mistake. I do not have to worry about it." And actually with exposure, we are saying, "Hey, let us just go into it. Let us not just avoid. Let us not just give up our fear but let us create these moments and celebrate them." And so shame attacking does this over-the-top way of diving in. I do encourage you to do it yourself before you ask a client to do it. And if you ever are in the Bay Area, I am your person. I would love to go out and do some shame attacking with you. It is super fun. I think I am probably the most odd person in downtown Mountain View because the amount of time I spend downtown doing goofy things in public. And I still get a little anxious every time before I do it which tells me I have got to keep it up, keep up the rhythm.

So this was something that we did with Kia. Actually all of these exercises are ones that Kia did in the course of her treatment. Let us talk a little bit about some of her outcomes. So she had specific learning from the exposure activities. She learned things like that she could in fact tolerate socially awkward moments that her anxiety did not stay that high but actually did come down with repetition. She also learned that people did not judge her as harshly as expected. An example of that was Kia was someone, remember she felt like she should not have an opinion or inconvenience anyone. And so one exposure she did was going into these bakeries. And she had to ask like three or four questions and then walk away without ordering anything. And this was atrocious to her. It was so awkward to her to do that. She felt like she was inconveniencing someone and putting someone out. And so her learning was people actually did not judge. Like there is space in the world for her to have needs and opinions. And it was really sweet and powerful overall in the treatment. And she picked up some larger learning like that her anxiety came down in normal daily social activities. She felt closer to a handful of other people. And she was doing greater social risk taking. So sharing her opinions more, feeling willing to vote for where they go to lunch or speak up about things in her groups. And I think that was contributing to her feeling closer to others. So we are going to do a couple summary points here. Going to remind you then about some resources to learn more. Make sure you have that CE survey and do some Q&A. Okay. So a few reminder points here. We want you to leave today remembering that social anxiety is quite common. That there is a number of common negative thoughts involved in social anxiety. A couple of the themes are that there is a low belief in their social abilities and a high belief in the costs. So the stakes are high and a perception that their skills are low. Anxiety is maintained by avoidance. And that exposure is the key to banishing avoidance. And so we want to think less talk, more exposure, less talk, more exposure and get them out there doing things.

So a couple of resources to help you dig further into social anxiety. When Panic Attacks is the name of the self-help book written by our mentor David Burns that specifically focuses on broader anxiety with lots of examples of social anxiety. And then below that you see my favorite treatment manual from the Treatments That Work series by Hope, Heimberg and Turk. They have both the therapist guide and a client workbook. You can use one, you can use both. Great resources in there including worksheets and helpful guides that you can use to supplement your work. And that fits really well within the TEAM-CBT model. It just gives you kind of some structure and information to facilitate your learning. And then of course, you have got access now. You know about FGI. We have all these certified trainers who can do consultation for you. People like LJ Davis and others that you could reach out to for case consultation. And if you are someone who believes in exposure but does not want to do it yourself, reach out to us. You could refer a patient to do a bit of exposure work with one of our therapists and then come back to you for the rest of their work. We believe in it so strongly. And all of our therapists here at FGI are equipped to do exposure with your clients. So if today's content has sparked interest for you and learning more about TEAM-CBT, I mentioned to you that we would tell you about a course. So we would love to invite you to join the fast track to Level 3 certification course. It starts June 20th. So right around the corner. And this is the most efficient and streamlined way for you to become a truly excellent TEAM-CBT therapist and really up your skills, up your game. I know this slide is packed. I do not expect you to read it all. It is just to give you a bit of a picture of what is included. I will tell you some of those highlights now. So it is a hybrid course, to make it accessible for folks who are busy and got lots going on. So you have 16 hours of asynchronous content that you do at your own pace. And then you get this really cool live half-day training that has a real time therapy demo with Dr. Burns which is really a neat special opportunity.

And probably most importantly, you get 25 weeks of small group coaching and live practice. I mentioned earlier that cycle, you learn something, try it, get feedback, try again. So that is deliberate practice. When you enroll, you will also get free Level 1 and 2 TEAM-CBT certification. So we will welcome you to the community with that. You will get free access to Level 3 exam prep. There is an exam to get Level 3 certification and David Burns full therapist toolkit which includes all of his materials like Shiveta mentioned, the Daily Mood Log and hundreds of other tools and techniques, mood surveys, things like that. New is we are offering a 30-day full refund because we believe so much in the course. We are saying, "Hey, give it a try. If you are nervous about it, if for any reason you are not happy with it, no questions asked. We will just refund your money." So you do not have to feel concerned about any risk. Mike already has or is about to put in the chat box a link if you are interested in registering fasttrackcbt.com. There should be a promo code there as well, skillup50 will give you $50 off your registration there. We get good feedback about the course all the time. This is Sarah Chickering actually who I know and adore and talked about this being one of the most transformative best decisions she has made professionally. Sarah, you are probably here today so thanks for sharing that quote with us. Cool. So let us do some Q&A.

Q&A Session