Social anxiety: Linking cognitive-behavioral therapy and strategies of third-generation therapies

Social anxiety disorder (SAD) is one of the most common mental disorders in the world. Sufferers report elevated levels of fear or anxiety in social situations because they believe that they could be negatively evaluated by others or because they fear acting in a way that is humiliating (because others are aware of their anxiety). Anxiety occurs even before the social event due to negative anticipations, and even after it people experience a lot of discomfort due to rumination and negative evaluations that persist about themselves and the situation. Given the social nature of people, social situations seem inevitable, and anxiety does not tend to diminish with regular exposure to these situations. On the contrary, it tends to persist over time and requires professional treatment. Usually, the impact that this disorder has on personal, social, or work life is usually what leads these people to consultation. This chapter briefly describes what SAD is, the multidimensional nature of social anxiety, age of onset, associated factors, course, prevalence, and comorbidity of SAD. Subsequently, a group treatment program is presented integrating the perspective of the traditional cognitive-behavior therapy (CBT) and the mindfulness and acceptance-based therapies (MABT), the new multidimensional intervention for social anxiety (MISA) program. This program combines mindfulness, experiential, acceptance, and cognitive defusion exercises, plus education in values from ACT and MBSR, with social skill training, cognitive restructuring, exposure exercises, and psychoeducation from CBT. The MISA program consists of 15 therapeutic sessions, plus two initial evaluation sessions, two posttreatment evaluation sessions, a booster session, and two follow-up sessions (one at 6 months and another at 12 months). This program could also be used in the treatment of generalized anxiety disorder, depressive disorders, or borderline personality disorder.