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Diagnosis & Treatment of Phobias with Cognitive Restructuring Interventions
Diagnosis & Treatment of Phobias with Cognitive Restructuring Interventions

Section 12
Track #12 - Overcoming Pain, Danger, and Public Speaking Phobias

CEU Question 12 | CEU Answer Booklet | Table of Contents | Phobias
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs, Nurse CEUs

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On the last track we discussed two causes of social phobia.  The two causes of social phobia that we discussed were shame and social image and fear of loss of love or abandonment.

On this track we will continue to discuss social phobias.  The focus of this track will be on public speaking phobias.  Four aspects of public speaking phobias that we will discuss are being able to function, the role of anxiety, performance feedback, and the phobic client’s cognitive set during speech.
 
The various disabilities and symptoms involved in severe public-speaking phobias encapsulate the various facets of evaluation phobias: vulnerability to being the center of scrutiny or to being judged harshly, negative predictions, reduced self-confidence, sense of incompetence, being handicapped by involuntary inhibition, impaired control of thoughts and speech, adherence to stringent rules, and expectation of “punishment” for breaking the rules.

Share on Facebook #1  Being Able to Function.  
First, let’s discuss being able to function.  Do you recall Brenda from track 7?  The first hope of a client like Brenda who attempts to speak in public is to be able to “function.”   To speak adequately, Brenda needed to be able to maintain an upright position, keep her balance, open her mouth, and speak intelligibly.  When she could not do this, she perceived that “she had no control over the functioning of her mind and body”—a devastating blow to her self-confidence.  
Since control over “mind and body” is ultimately essential for survival, the undermining of functioning by the primal mechanisms represents a symbolic threat.  Specific symptoms such as swaying, a quavering voice, faint feelings, loss of fluency, rigid postural control, all meant to Brenda, “I can’t control myself—I can’t perform adequately—Anything can happen to me.”  Brenda’s sense of being victimized by internal pro­cesses was similar to the experience of the agoraphobic, except that it does not imply the presence of a life-threatening or disintegrating disorder.

This demonstration of lack of control is perceived (or so Brenda believed) by the audience. Brenda then experienced not only the fear of being unable to function but also the greater fear that this lack of functioning would be judged by the audience as an indication of her “sickness, nervousness, immaturity, neurosis, inadequacy.”

Share on Facebook #2  The Role of Anxiety
Next, let’s discuss the role of anxiety.  Would you agree that the initial anxiety which accompanies phobic reactions serves as a “stimulus” to further negative conceptualizations.  First, the unpleasant experience itself served to distract Brenda from the task at hand just as would a sudden sharp pain.  Secondly, she interpreted anxiety as a dramatic sign that she was already not functioning well (and will not function well).  

The anxiety itself, rather than any focused systematic assessment of her capability, was taken as the index of dysfunction.  Brenda stated, “I always feel that it’s a sign that I’m not making it.”  Next, Brenda’s global self-confidence was eroded.  As her attention is diverted to her anxiety, and as her cognitive-motor apparatus is diverted to danger, there is an increase in her overt “nervousness” as well as increased difficulty in performance.  Think of your Brenda.  How does initial anxiety evolve into a phobic condition?

Share on Facebook #3  Performance Feedback
In addition to being able to function and the role of anxiety, let’s discuss performance feedback. 
Brenda, like other clients with public-speaking phobias, uses feedback from the audience to tell her whether she is effective.  If the response is negative, then her functioning is likely to suffer.  If Brenda decides that the audience considers her inadequate, this judgment may activate her notions of inadequacy and trigger non-adaptive “protective” responses.  

She may become disabled, impaired, possibly even mute.  In actuality, Brenda could function if she believed that she was capable of functioning in these circumstances.  The negative response from the audience makes her believe that she cannot function at a good level, and thus starts the vicious cycle of phobic reaction.  The dysfunctional attitudes “interact,” are often accentuated by a negative response from the audience, and lead to a barrage of negative thoughts (“They can tell I’m nervous. They believe I’m weak. They’re downgrading me”).  

As a result, does your client subjectively experience a decrease in her sense of being able to influence the audience?  Does he or she feel her power draining out of her?  As Brenda became increasingly “weak and powerless,” she sensed great danger and felt vulnerable to attack or disapproval from the audience.  The net effect was a catastrophic drop in her confidence in being able to depend on her functional capacities to see herself through the perceived crisis. 

Share on Facebook #4  Cognitive Set During Speech
Finally, let’s discuss the phobic client’s cognitive set during speech.  Brenda’s cognitive set prior to presenting a speech included a wide variety of negative attitudes and evoked unpleasant cognitions.  Brenda described her overall cognitive set when she stated, “The audience itself is threatening because they are ready to pounce on any misstep.  My audience expects me to speak clearly and articulately, that my content is interesting, that my manner is free and confident, but not too casual or informal.  That’s to much to live up to!” 

Brenda believed that any deviation from these expectations would evoke a critical response.  Her self-perception was that she would be naked, exposed, and inadequate; and, furthermore, that she would suffer crippling inhibitions and painful anxiety which would impair her performance and open her to criticism or ridicule.  Is your client’s cognitive set manifested in automatic thoughts such as “I won’t be able to do it”; “They will be disappointed in me”; or, “I will make a fool of myself?”

At the onset of the speech, the cognitive set consists of self-monitoring and evaluation of the audience response. This set is represented by negative evaluations and dire predictions.  Brenda explained that she often had thoughts such as, “I look silly”; “I’m not expressing myself well”; “I’ll forget what I want to say”; “I sound childish”; “I won’t be able to go on”; “I’ll be forced to stop”; “I’ll be disgraced.”  Brenda’s interpretation of the audience response was based on selective focus.  She expressed such thoughts as “They’re bored”; “They think I look pathetic”; “They wish this was over.”

The cognitive set thus primes clients like Brenda to meet a danger, resulting in a textbook fight or flight response which, as you know, is not conducive to the public speaking arena.  Think of your Brenda.  How might you analyze your client’s public speaking phobia regarding his or her cognitive set?

On this track we discussed social phobias.  The focus of this track was on public speaking phobias.  Four aspects of public speaking phobias that we will discuss are being able to function, the role of anxiety, performance feedback, and the phobic client’s cognitive set during speech.

On the next track we will discuss two techniques for overcoming social phobias.  The two techniques discussed on this track are decentering and time projection. 

Online Continuing Education QUESTION 12
What are four aspects of public speaking phobias? To select and enter your answer go to CEU Answer Booklet.

 
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Diagnosis & Treatment of Phobias with Cognitive Restructuring Interventions

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