CBT for Social Anxiety Disorder: Using downward arrow and thought challenging techniques

Case study example for use in teaching, aiming to demonstrate how the downward arrow technique and thought challenging might be used in CBT for social anxiety disorder. The character of Hannah is played by an actor (Malak El-Gonemy), but the scene is not scripted, and as such it represents a natural therapeutic exchange.

The video was filmed and produced by Ishan Siddiqui and Christopher Werrett.


  1. I would avoid using the same 'what would be so bad…' line of questioning for this technique. If you use this repeatedly it starts to give the impression you are minimising your clients suffering. Consider using phrasing such as 'if that were true, what would that say about you?' or 'what does that suggest?' or 'why does that bother you do you think?

  2. There's no way this lady is a clinical psychologist. This approach is so mechanical and rehearsed. She's treating a dysfunctional brain like dysfunctional software. We're more than zeros and ones. This video is trying to communicate a point like a romantic movie does. When it's dond, you're supposed to assume that it will last forever. Whatever insight the girl moght jave had, she WILL forget it, she will experience anxiety and she will not remember a single thing from this session. That's just how hyppfrontality works. And if you don't wanna think in those terms, let's look at it psychodimanically, or rather existentially….there's a reason she has anxiety, whatever it might be and not addressing and processing it is like giving an aspirin to someone woth traumatic brain injury. Ok, that's a hyperbole, but the analogy stands. I guess my point is that if you're gonna make a video about cbt, you cannot, ypu just cannot omit the information that it's a gradual, non-linear process…and how might one do that? Idk, since this is clearly staged, just make a scene woth the girl texting and lying about reasons for not going..idfk, just not this. All you'll 've done with this video is enable people to wallow in their own disorder by watching skmething that resonates with them…that's not enough. Also, the constant "What would be so bad about that?" at the beginning os a clear indicator that the therapist is not fully mentally present. What do you mean? Why would you ask what would be bad about feeling excluded? That's the most powerful negative emotion we have as a species. Being driven by that fear is what brought us here as a species…that's what differentiated us from other primates(I think it was neanderthals vs. Homo erecti, not sure, doesn't matter). That's like asking what would be so bad about feeling hungry after not having eaten for five days. That's not a cognitive problem, that's as existential as it gets.

  3. My brothers and sisters who has social anxiety pls dont waste time and money to doctors who cant heal u.If they cant heal reason(narcis,sociapaths,psyhopats) then how they can heal result(shizoprenics,men who has social anxiety.Ask doctor what do they heal reason or result?Goodness or Evil?Ownselves or ills?Just accept pain then u will find calm.Dont run away from pain coz pain is the truth.Only with pain u can return to God.Dont let sociapathic,narcissistic,psycopathic psychiatrs to take empathy,pain from u.Evil first hurts u then tries to heal u to think that evil is rescuer.Evil is everywhere in science,in art…..Evil has its own working mechanism.Ask yourselves why sociapthic,narcissistic,psychopatic leaders,ministers rule countries,this world.Why 90 percent of psychologs and psychiatrs are narcissistic,sociapthic,psychopatic.God bless u.

  4. I've been dealing with social anxiety since I started high school. I always feel like people will ignore me or judge me, since most people are fake in high school. I'm still struggling with it and I'm in college, I want to give my truthful opinion on things, but for some reason I get nervous and scared when that happens and I always get left behind. I want to change but it's really hard. I understand what that girl feels and says. I want to talk again, I want to enjoy my life again, I want people to know me and not know me as the quiet kid who is serious and strange. Thinking too much before talking and being socially anxious has negatively impacted my life. I'm meeting a counselor now and I'm getting better. Anyone that struggles with this , I hope you overcome it becuase it's difficult even as a young adult like me knows this is difficult. Good luck and take care guys and let's defeat our social anxiety.

  5. "What would be so bad about all that?"

    Because I already fucking hate myself and I'm sick of being viewed in a certain way and I'm fucking tired of rejection and having to constantly fucking try to calculate how everyone is going to react to something I do and then feeling like shit if someone says ONE thing that I take as a put down or any sort of negative response. Oh and I'm fucking sick of being lonely. I DON'T WANT TO BE SEEN AS WEIRD.


  6. The best cure for SOCIAL ANXIETY is to drink a strong coffee right before the social situation, ALSO smoke some weed.

  7. I went to my sisters baby shower for support and I hated everything minute of it…. at first I was walking around like a dumbass I didn’t know what to do.. I took a few pictures till eventually I finally found somewhere to sit down and I just stayed there to hole time on my phone that’s not even connected and there’s no damn WiFi so I just played the game flow the entire time… it was so boring I almost cried because I was thinking about suicide I don’t cry tho because there was a lot of people around so when it was over and I left and I was in the car I just cried in silence and made sure no one can see my face

  8. I have nothing to talk about tho idk how to socialize… once I was with a friend of my I was comfortable with but she asked me to come sit with her friends for lunch and it was awkward af I didn’t say anything and she keep saying out loud.. “come on, socialize” and I could see her friend looking at me with this is very awkward and that made me feel worse

  9. Didn’t restructure the thought after the belief reevaluation, e.g I’m not worth being friends with —> sometimes I feel like I’m not worth being friends with but there are plenty of reasons that make me a good friend

  10. Are all CBT sessions like this?? If so I don't want to go. To many questions would make me feel like walking out and running home with serve anxiety 😭

  11. Okay the amount of questions she asked about the same thing With obvious reasons just makes me feel anxious. I wouldn't want this woman to help me

  12. Social phobia is an extremely debilitating condition. People with social anxiety disorder /panic disorder have a very tragic life. Help them

  13. Who TF wants to be around their fam? ppl who claim fam probs and then tlk abt being w fam is soo contradictory! Yea they're that bad!

  14. Anybody that comes to this video and has Social Anxiety, like me..i feel like we should start a group chat or something so that we have others like us to talk to since, we will all understand each-other….This shit is lonely and depressing.

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