CBT for social anxiety: questions to ask about treatment

Cognitive behavioural therapy, or CBT, is a talking therapy that explores relationships between thoughts, feelings and behaviour. For social anxiety, treatment should address the person's particular fears and difficulties, rather than simply tell them to be more confident.

NICE recommends individual CBT developed for social anxiety disorder for adults with that diagnosis. This is a treatment recommendation, not a promise that every person will have the same experience or outcome.

Start with an assessment conversation

Describe what social anxiety stops you doing and what you would like to be able to do. A goal might be attending appointments, speaking in a meeting or spending time with friends without lengthy worry afterwards.

You do not have to arrive with a perfect explanation. A written example can be enough to begin.

Try: “I avoid situations because I worry about being judged, and I spend a long time reviewing conversations afterwards. Could we discuss whether CBT is appropriate for me?”

Ask how the assessment considers other needs, including communication preferences, sensory difficulties or another health condition. An accessible conversation is part of understanding your circumstances.

Ask what the treatment involves

It is reasonable to ask how sessions work, what activities might happen between appointments and how goals are agreed. You can also ask what to do if an exercise is confusing or feels too difficult.

Useful questions include:

• What will we work on first, and how will we decide together?
• Can instructions be written down?
• How will we review whether this is helping with my own goals?
• Who should I contact if my circumstances or support needs change?

These questions do not make you a difficult patient. They help you understand what you are being offered and participate in decisions about your care.

Distinguish therapy from everyday practice

Writing a conversation opener or rehearsing a question may help you prepare for a real situation. That does not make a script library a course of CBT. Equally, a therapist's work is not limited to positive thinking or reviewing past events.

If you already have a treatment plan, ask how any app or self-help exercise fits it. Do not turn a suggested behavioural experiment into a test you feel you must pass perfectly or repeat until all anxiety disappears.

A useful question: “Would this preparation help my plan, or am I using it to keep checking that nothing uncomfortable will happen?”

Finding an appropriate route

Your GP or a local talking therapies service can explain available options. Routes differ between UK nations and services. Our NHS social anxiety guide focuses on preparing that first contact.

tonen provides everyday conversation support. It is not CBT, a therapist or a substitute for assessment. You can use the questions on this page without downloading anything.