One of the major concerns presented in Jeremiah's case is his social anxiety. Social Anxiety Disorder also known as Social Phobia is a disorder characterized by an intense, irrational fear of humiliation or judgment by others in social settings. Although it is normal for individuals to experience anxiety in certain social situations, people suffering from social anxiety experience excessive fear and discomfort, and are self conscious thus their fear of interacting with other people in various social settings is heightened as they are constantly worried about being scrutinized. The intense anxiety thus causes impairment in functioning and significantly interferes with the individuals' relationships and lives.
From a cognitive theoretical perceptive, people suffering from Social Phobia constantly engage in cognitive thought processes that involve irrational and excessive threat assessments that lead to exaggerated thoughts about the associated distress of potential negative outcomes. Additionally, socially anxious individuals have a negative image of themselves in social settings. Cognitive theory states that such negative perceptions and over-estimation of negative outcomes are as a result of a negative self image and perceptions that are reinforced with every social interaction experienced by an individual suffering from social phobia (Castriotta, 2013). The development of a negative self perception can be attributed to the family environment that plays a critical role in social anxiety. If one has an anxious parent, the risk of experiencing social anxiety increases. In Jeremiah's case, he described his mother as being a "worrier." From the perspective of the cognitive theory, the constant reminders by Jeremiah's mother to be careful, to not get into trouble and not act like a spoilt brat consequently led Jeremiah to perceive that he was in fact acting spoilt. Decreasing or entirely avoiding social interactions would thus be an appropriate response that ensured he would not embarrass himself or the family.
Subsequently, the client's Social Anxiety Disorder most likely led to his second concern, alcoholism. Although not all alcoholics suffer from social anxiety and vice versa, many individuals that suffer from social phobia also state that alcohol enables them to act more freely and feel more comfortable in social situations. Thus, in most cases, individuals suffering from social anxiety turn to alcohol as a mean of relief (Anxiety and Depression Association of America, n.d.). "Liquid courage" as it is typically referred to by people suffering from social anxiety, alcohol is linked with enhanced confidence and reduced inhibition prompting those with social anxiety to see it as a relief for their symptoms.
Although the debate on whether alcohol reduces anxiety is still ongoing, from a cognitive theory point of view, the positive perceptions and expectations that it reduces social fears explain why many socials anxious individuals turn to alcohol as a coping mechanism. In Jeremiah's case, he openly admits that he needs alcohol to get through certain social situations (I don't think I can get through something like that without a drink), thus he views alcohol as a negative reinforcement to reduce anxiety. Consequently, once a person anxiety decreases after using alcohol, the individual is more likely to continue consuming alcohol in or prior to perceived stressful situations.
The cognitive treatment interventions appropriate for treating Jeremiah's social anxiety would involve processes that address the cognitive biases that operate in social anxiety. The cognitive area of the treatment refers to thinking, a section that can be taught to the client through repetition. Thus, by identifying the thoughts that are triggered in the anticipation of a social event, that is, the feeling that by accepting an invitation to attend a social event-a football game-the woman who invited him would find out that he is pathetic and a loser, cognitive techniques such as reality testing where the therapist helps the client to challenge the automatic negative thoughts with realistic information about the situation, and thought stopping, whereby the client constantly attempts to stop the negative thoughts when he experiences them, can be utilized to counter the client's social anxiety (Garda, 2007).
The cognitive treatment in this case would involve the client practicing new positive thoughts of self via repetition when he is in a social setting and notices negative thoughts arising. For instance, in Jeremiah's case, he might replace the anxiety inducing thoughts of, "even if she went out with me she would soon see that I'm a loser," with "these feelings are irrational and unfounded. She invited me because I am an interesting person. At the very least, this is an opportunity to make a new friend." By practicing such new thoughts, new and positive patterns of thinking will eventually become automatic thus alleviating his Social Anxiety Disorder.
Recovering addicts' meetings such as Alcoholic Anonymous meetings are also a good way to treat both alcoholism and Social Anxiety Disorder. Such meetings would allow the client to gradually gain the confidence to attend and be active in social situations. From a cognitive theoretical perspective, they allow the client let go of the negative perceptions they have about themselves as in such a setting, all the people in attendance are flawed; that is, they are all alcoholics. Thus the client is able to gradually start identifying positive aspects about themselves and form a positive self-image. However, in some instances, such meetings can also be anxiety inducing, thus, this avenue of treatment should be pursued only after the client has worked with a therapist on a one-on-one basis.
Anxiety and Depression Association of America. (n.d.). Social Anxiety Disorder and Alcohol Abuse. Retrieved from Anxiety and Depression Association of America: https://adaa.org/understanding-anxiety/social-anxiety-disorder/social-anxiety-and-alcohol-abuse
Castriotta, N. N. (2013). Anxiety and Avoidance: The Relationship, Function, and Measurement (Doctoral Dissertation). Retrieved from https://escholarship.org/content/qt9q13f1rs/qt9q13f1rs.pdf
Garda, Z. (2007). 'It's Just Your Imagination': Fantasy Proneness and Social Anxiety (Master's Thesis). Retrieved from https://pdfs.semanticscholar.org/5f63/e0ff341f1bdf228733c2213e2b0a36289dcb.pdf
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