Written by Dr Kate Beaven-Marks
With the majority of hypnotherapy being conducted online at the moment due to Covid restrictions and lockdowns one type of client that may struggle with this is the client with social anxiety or shyness when online. To have to communicate online may have a considerable impact on some clients if they are required to work or study from home where they don’t normally have to. This may be an expansion of their existing social anxiety (e.g. speaking to strangers in public, speaking up at work or in class), or it may be specific only to online situations.
Most people will say that they can feel a little shy or anxious in certain leisure or work environments. For some though, the feeling is stronger and present in more situations. This can have a limiting effect on someone’s day to day life, whether that is within friendships, leisure activities, school/university or work.
How people experience their social anxiety can vary from person to person, and can also be situation/context dependent. Commonly, clients may report feeling stressed, anxious, or ‘on edge’, before or during an online session, and during the session they may say that they feel self-conscious or exposed. This may lead to the client behaving differently (or feeling that they are) in online settings, leading to embarrassment. Self-monitoring may then cause a cycle back to stress and anxiety and an ongoing loop. The client may also report a range of perceived or actual physical symptoms, such as sweating, blushing, racing pulse, trembling voice, a churning stomach (or ‘butterflies’) and rapid breathing, which can lead to dizziness or feeling light-headed. As well as emotional and physical symptoms, the client may be aware of intrusive thoughts about the situation e.g. “everyone is looking at me” or negative self-talk, such as, “I look stupid”, “I don’t say anything of value” or, “I can’t cope with this”. This self-talk can be prior to an event, predicting how bad it will be, during an event, feeling that everyone will be thinking poorly of them, or afterwards, when they may reflect on each aspect of the event and beating themselves up about what the perceive they did badly. These symptoms can lead to a range of unhelpful behaviours and coping strategies, especially avoidance (e.g. making excuses not to work online), withdrawal (e.g. staying quiet and not contributing to discussions), and self-soothing (e.g. alcohol/food).
There are many potential causes that can generate social anxiety, such as conditioning. For some clients, a single event can result in the development of social anxiety. They may have been totally fine until one significant event where they performed poorly or felt humiliated, embarrassed or another negative strong emotion. For others, it could be a series of minor events which cumulatively lead the client towards a negative mindset. It may be that the client had already experienced social anxiety in ‘in-person’ situations, or it might be that their first experience of social anxiety is when they are online. Where someone in a client’s family has social anxiety, this can have an influence, whether that is because family tend to have similar personality traits, or a ‘modelling’ (copying) of behaviour, or even a way of fitting in. Whichever causative route, the client will start to negatively anticipate and worry about similar situations, and that they may have similar outcomes. This worry can lead to fear and anxiety, which can affect how a client thinks and behaves, thus reinforcing their perception of a negative outcome.
Social anxieties can persist without intervention. They can be maintained by negative thinking strategies (before, during and after events), emotions (such as anxiety) and behaviours (including avoidance, safety behaviours, and directed self-monitoring, where a person looks for evidence to support belief that the situation is/will be/was terrible). For example:
Situation: Speaking to a group of family members online for a catch up
Thoughts: I don’t have anything to contribute. They will laugh at me. I am stupi
Emotions: Anxious, self-conscious, on show.
Sensations: Blushing, sweating, fast breathing
Thoughts: Everyone can see I am anxious, they will think I can’t cope.
Emotions: Heightened anxiety, feel more self-conscious.
Actions: Withdraw, avoid speaking, make an excuse to log off
Thoughts: I couldn’t cope, I did badly.
Hypnotherapy for social anxiety
The socially anxious client’s first contact with a hypnotherapist is likely to be by email (easier from them to control the interaction), or possibly by phone. They may also ask for therapy via the phone, rather than internet (e.g. Zoom, Skype). It is certainly more optimal to be able to see your client when engaging in work in hypnosis. As such, if a client is initially uncomfortable working online, and you are unable to see them in person, some work outside of hypnosis, conducted via telephone can start the change process. It may be appropriate to conduct the initial consultation and work from a cognitive perspective (out of hypnosis) via a phone call, in order to help them become more comfortable with accepting therapy online.
When working with clients experiencing social anxiety, whether in person, or online, both cognitive and behavioural approaches can help a client achieve meaningful change. Helping the client learn how to identify and challenge their unhelpful thoughts and then find more realistic ways of thinking can be really beneficial. During a consultation, you may start to become aware of one or more cognitive distortions that the client is experiencing, such as ‘black or white’ thinking (e.g. something is either 100% good or 100% bad) or mind reading, (thinking you know what someone is thinking, even if there is no supporting evidence).
Just challenging a client’s thoughts in the session can be helpful, but the client may come to rely on the therapist’s help in using the thought-challenging process. Whereas, if the client learns how to do this for themselves there is more impact over time. When you are able to work online with your client, then this cognitive work can be reinforced in hypnosis, together with the use of future pacing to practice new thinking strategies and teaching the client mental rehearsal. There are many questioning approaches that you can teach a client to explore their unhelpful thoughts. Some of the popular approaches are listed below. A running example of someone with anxiety about speaking up at an online meeting is used.
A range of perspectives
Question: What are three (or more) ways of thinking about this situation?
- One – Speaking up at an online team meeting will mean people may laugh at me.
- Two – Staying silent at a team meeting means by views are not considered.
- Three – Speaking up at an online team meeting is little different to speaking up in person.
Question: What are the costs and benefits of thinking this way, versus the costs and benefits of thinking more positively?
- Old thoughts – cost: It makes me anxious even thinking about talking at an online team meeting.
- Old benefits – benefits: It stops me talking in a team meeting, so no-one will laugh at what I say.
- New thoughts – cost: I will have to focus thinking and acting helpfully.
- New thoughts – benefits: I will become more confident each time I do well.
Question: Are there any cognitive distortions in this thought?
Note: You could give the client a worksheet listing cognitive distortions and examples.
- Thought: “My colleagues think I am useless because I don’t speak up.”
Question: Is there any evidence that contradicts that thought?
- Thought: “I cannot say anything useful in online team meetings.”
- Evidence against: “I contribute ok when I am physically at work, with the same people.”
As well as working cognitively, the therapist can help the client to identify their social anxiety behaviours (e.g. self-monitoring, avoidance, withdrawal) and identify and practice new more helpful behaviours. This can be done within the session, out of hypnosis (e.g. talking/role play) and in the session, both as visualisation work and during future pacing.
It can help the client direct the client’s focus, so that they learn to avoid focusing on physical sensations and focus on the conversation, and what is being said and done, rather than what is going on with themselves. You might also use ‘desensitisation’ in hypnosis, creating a hierarchy (a list) of aspects of the situation that generate anxiety, and SUD scaling it (how disturbing each element is, from 0 to 100). E.g.
- 10 Thinking about talking online
- 30 Looking at self on screen
- 50 Thinking about saying something in a meeting
- 70 Being asked a question during online meeting
- 90 Raising a point of discussion during an online meeting
- 100 Giving a presentation to a small group of colleagues
You can then use imaginal (and/or real-world) desensitisation to help the client become more comfortable with the identified scenarios. Then, future pacing and mental rehearsal can help the client become more comfortable in future situations.
In summary, there are many similarities in approach when using hypnotherapy to help clients let go of social anxiety or social shyness, whether in face-to-face situations, or online. However, unlike most clients who are happy to work online when face-to-face isn’t possible (e.g. during lockdown), those with online-specific social phobia, anxiety or shyness can initially be challenging if a client is not able to join you online. Hopefully this blog has given you a number of useful strategies and approaches that can help your clients let go of unhelpful thoughts and behaviours and develop positive new strategies. If you would like to find out more about any of the techniques mentioned here, they all form part of our Live Online Hypnotherapy Certification Course and our (in-person) Hypnotherapy Diploma Course.
If you have any questions about this topic or anything else for that matter, do please get in touch, because we’re always happy to help!
– written by Dr Kate Beaven-Marks