Social anxiety and fear of judgement

When he first called, he had spent three years declining presentations at work on the excuse of a cold. His fear of being judged had become so strong that his sleep was broken and he had already lost several work opportunities. Initial testing put his social anxiety score in the severe range.

The first job was to make the relationship between worry and behaviour explicit. In the early sessions we drew a map of the avoided situations together and saw that he was avoiding three simple situations almost every day.

Treatment then ran on three fronts: working on unfounded beliefs about other people's judgement, practising arousal-reduction techniques in small situations, and building an exposure ladder that moved one rung a week, each rung recorded in the client's own written notes.

In the fourth month he gave his first real presentation and finished it, and the session a week later was held calmly and without long preparation. By the end, his social anxiety score had moved from severe to mild, and more importantly he no longer had a daily routine for avoiding people. He now has a follow-up session every six months.