Emotion-focused therapy for social anxiety (EFT-SA)

Social anxiety (SA) is a common, disabling difficulty characterized by persistent fear of other people. After a brief clinical description, we present an emotion-focused therapy (EFT) theory of SA: We describe its developmental origins in experiences of social degradation, which result in primary emotional processes organized around a core sense of shame-ridden defective self. These give rise to secondary reactive anxiety that others will see the person’s defectiveness, organized around a coach/critic/guarding aspect of self that, in the process of trying to keep the person safe from exposure, inadvertently generates the emotional dysregulation characteristic of SA. Following this, we present a model and case example for working with SA via an emotional deepening process that begins with accessing secondary reactive anxiety of others in particular situations and then works backwards to accessing and activating primary maladaptive shame so that this emotion scheme can be restructured within a secure, accepting therapy relationship. We conclude with a brief summary of evidence for EFT-SA and some final thoughts about how working with this client population has changed our EFT practice.