academyofcbt

Dating with Social Anxiety in the Digital Landscape

Mon, 20 Apr 2026 18:26:01 GMT

Dating with Social Anxiety in the Digital Landscape

by Chamin Ajjan, LCSW, A-CBT, CST

Technology has undergone a major shift. It is no longer just a tool we use; it has become the environment we inhabit. For those living with Social Anxiety Disorder (SAD), this digital landscape often serves as a "functional replacement" for actual, in-person dating. Instead of facilitating growth and real connection, it frequently reinforces safety behaviors and provides a digital fortress for avoidance.

In my work as a therapist and as the author of Seeking Soulmate: Ditch the Dating Game and Find Real Connection , I’ve seen how the very tech designed to connect us can actually keep us isolated. In my practice, we run a CBT skills group for social anxiety, and for many of our clients, social anxiety shows up most clearly as dating anxiety or sexual anxiety. This particular struggle has become increasingly prevalent, reflecting a broader trend in which the digital world complicates the search for intimacy.

Technology is not inherently bad. The trouble comes with how we use it. It is time for clinicians to explore the "digital shields" our clients are using to regulate a nervous system that feels constantly under threat. We must also examine our own biases about technology as clinicians. This is an urgent clinical issue.

The Architecture of the Digital Fortress

For someone with SAD, the friction of a real human relationship—including awkward pauses, the risk of "no," and unfiltered vulnerability—can feel like a threat to their safety. Technology offers a sterile alternative, but it comes at a steep price.

AI Chatbots: These rising platforms offer simulated romance in a completely rejection-free environment. While they provide immediate comfort, they can lead to an intolerance for the natural, messy friction of real relationships. If your "partner" never disagrees or rejects you, the real world begins to feel increasingly unsafe and threatening.

Dating Apps: From mainstream apps like Tinder, Hinge, and Bumble to exclusive ones like Raya or Luxy, these platforms are often used for "digital window shopping." They allow the anxious dater to feel like they are "doing something" without ever having to risk a live encounter.

Smartphones: The ultimate digital shield. In physical social spaces, the phone is used to avoid eye contact or to look "busy." This prevents the habituation of social discomfort—the very process needed to realize that perceived social “danger” is often driven by distorted thinking rather than reality.

AirPods and Headphones: These have become the modern "Do Not Disturb" sign for the physical world. By wearing them in public spaces—elevators, coffee shops, transit—a person signals they are socially unavailable. While they may provide a sense of safety, they act as a barrier to spontaneous human interaction. They can also contribute to post-event rumination, as individuals retreat into isolation and overanalyze interactions.

Intimacy Fragility and the Vulnerability Paradox

High-frequency use of AI-simulated romance or curated sexual content can create a state of intimacy fragility—a delicate state in which emotional or sexual bonds are easily fragmented rather than resilient. It is characterized by a "vulnerability paradox," where the closeness required for true intimacy is experienced by the nervous system as a dangerous risk.

Real intimacy involves uncertainty, the possibility of rejection, and the need for presence. In fact, it is often this very uncertainty that reinforces reward-based learning and strengthens approach behavior. Technology offers a sterilized version of connection that can make real-world vulnerability feel too loud and overwhelming.

As therapists, if we are not exploring a client’s digital life, we are missing half the picture.

The Algorithm of Anxiety

We must remind our clients that algorithms are designed for engagement—not wellness. If a person is anxious, they are more likely to be served content that reinforces that anxiety, creating a feedback loop of online negativity.

This kind of digital reassurance—such as repeatedly asking, “Is this message okay?”—prevents clients from learning to trust their own social judgment and keeps them dependent on external validation.

From Insight to Intervention: A CBT Framework for Digital Dating

To move clients out of the digital fortress, we must translate insight into behavior change. From a CBT perspective, digital avoidance functions as a safety behavior that prevents disconfirmation of feared outcomes.

Some practical intervention targets include:

Identifying digital safety behaviors. Help clients recognize patterns such as over-editing messages, repeatedly checking profiles, or staying on apps without progressing toward real interaction.
Setting behavioral benchmarks. For example, helping clients move from matching, to messaging, to a phone call, and eventually to an in-person meeting within a defined and reasonable timeframe.
Tracking avoidance loops. Encourage clients to monitor when they are using technology to regulate anxiety rather than engage in meaningful connection.
Shifting from outcome focus to exposure focus. The goal is not to “get the date,” but to practice tolerating uncertainty, rejection, and vulnerability.

These interventions help clients test their fears in real-world situations and build confidence without relying on digital safety behaviors.

The Digital Screening: A New Clinical Necessity

As an AASECT-certified sex therapist, I have long advocated for thorough sexual assessments as a vital lens into a client's wellbeing. I am now making a similar call: we must perform digital screenings.

When working with daters, we need to ask the hard questions:

"Are you using this app to connect, or to regulate a nervous system that feels under threat?"
"How do you use AI? Do you view your AI as a friend, mentor, assistant, or lover?"
"How often do your digital connections lead to in-person dates? How long is the lag between the first swipe and the first hello?"
"How do you feel after you spend an hour on social media? Does it help or hurt your sense of self-worth?"

Moving Toward Mindful Connection

In Seeking Soulmate , I discuss the CBT “equilateral triangle” of thoughts, feelings, and behaviors. If our behaviors remain strictly digital, our thoughts and feelings will stay trapped in a loop of avoidance.

Mindful dating is about bringing awareness to our romantic encounters and using that awareness to remain present and open. It requires stepping outside the digital fortress and lowering the shield.

Building a Digital-to-Real Exposure Ladder

For clients with social anxiety, dating should be approached through gradual, structured exposure:

Sending a message without excessive editing
Initiating a conversation
Suggesting a phone or video call
Tolerating delayed responses without reassurance seeking
Asking for an in-person date
Attending the date without relying on digital distractions (e.g., checking the phone)

At each stage, the goal is not just task completion, but the reduction of safety behaviors that interfere with emotional learning.

Clinical Tip: Digital Rules That Support Exposure

Encourage clients to adopt simple behavioral guidelines such as:

Limiting message edits before sending
Moving off apps within a set number of days
Scheduling app use intentionally rather than checking based on anxiety
Reducing use of phones or headphones as social shields in public settings

These small but meaningful shifts help move behavior from avoidance to intentional exposure.

Mindful dating is not about eliminating anxiety—it is about engaging with it differently. When we help clients step outside the digital fortress, we are not just helping them date. We are helping them relearn that discomfort is not danger—and that meaningful connection requires risk.

Connect & Learn More
Visit Chamin Ajjan’s website: https://chaminajjan.com

Learn more about Chamin Ajjan's book:
Seeking Soulmate: Ditch the Dating Game and Find Real Connection https://www.amazon.com/Seeking-Soulmate-Ditch-Dating-Connection/dp/1941529577

About the Series
The A-CBT Blog & Author Spotlight Series features contributions from Diplomates and leaders in cognitive and behavioral therapies, highlighting what high-quality CBT looks like in everyday clinical practice. To be considered for this series, A-CBT Diplomates and Fellows can contact katymanetta@gmail.com

Want to dive in further? Check out our YouTube:

Expanding Access to CBT Training: A-CBT and Renewal & Reward Center Launch Additional Cohorts

Thu, 09 Apr 2026 19:17:59 GMT

A Training Model Designed for Real Clinical Competence

Following the success of initial cohorts, the Renewal & Reward Center (RRC), in collaboration with the Academy of Cognitive and Behavioral Therapies, is expanding our partnership to train three additional cohorts of mental health professionals.

This work reflects a shared commitment to increasing the number of well-trained CBT clinicians and improving access to effective, evidence-based care across communities. The program integrates foundational learning, clinical supervision, and real-world application—including a unique in-person CBT clinic where trainees engage in live observation and receive immediate feedback from supervisors and peers.

To learn more or apply, visit: www.renewalandreward.com/cbtrrc

Bring This Model to Your Team

A-CBT partners with behavioral health systems, agencies, and organizations to deliver structured CBT training programs that go beyond theory and lead to real clinical competence.

If you’re exploring options for:

Foundational CBT training
Advanced skill development
Train-the-trainer / clinical champion models
Ongoing consultation and fidelity review

We should talk.

Contact us to learn how a customized CBT training program could work for your organization.

Assessing AI Use in CBT: A Modern-Day Ritual

Thu, 19 Mar 2026 23:57:24 GMT

I became a new mom over the last year and, as many people know, that experience completely rewires your brain. For me, it was not just the sleepless nights or the existential panic over whether my baby would nap for more than 27 minutes. It was the hormonal wiring for danger, turned up to warp speed. I found myself thinking things I would have laughed off before parenthood. The number of times I imagined tripping down the stairs or wondered whether eating .25 fewer ounces could somehow derail my infant’s entire day was absurd. Yet in the moment, it felt so real and urgent.

I looked for answers wherever I could find them: books, friends, our pediatrician, and increasingly, AI. Yes, I asked ChatGPT so many questions about my baby’s sleep, his health, his routine, development markers—you name it. Part of this stemmed from the lack of community many of us have as parents in today's world, ironically fueled by technology itself, and part of it stemmed from my desire to keep my son safe. And the irony wasn’t lost on me; as an exposure therapist, I spend my days helping people step out of reassurance loops. These questions were quietly reinforcing my anxiety. As I leaned on AI support more, I was relying less on my own intuition and more on a machine to tell me what to think and do.

I’ve watched this dynamic unfold in my patients for years - using Google, symptom checkers, calorie apps, texts to partners, or late-night forum scrolling. While the medium shifts, the mechanism stays the same. Could AI be a new form of reassurance-seeking? A digital ritual maintaining anxiety in ways we had not fully accounted for in CBT assessment?

The Modern Ritual: AI as a Safety Behavior

In cognitive behavioral therapy (CBT), we focus on how thoughts, feelings, and behaviors interact in a cycle. When anxiety rises, the behaviors we use to cope can either reduce fear over time or unintentionally strengthen it. In CBT, we often talk about reassurance-seeking and safety behaviors—strategies that temporarily reduce anxiety but maintain symptoms long term. Traditionally, this might include repeatedly calling a friend to ask if something is okay, checking the stove multiple times to make sure it’s off, or reviewing a conversation over and over when you’re trying to sleep. Now, AI platforms have joined this repertoire.

I have observed this AI-as-reassurance pattern across clients with OCD, generalized anxiety disorder, social anxiety, postpartum anxiety, and low self-esteem. Some recognize it as ritualistic while others do not. Some use it throughout the day, constantly asking questions or having full conversations. Others turn to it just when a trigger appears. A common theme we see in treatment is reliance on AI to answer questions that might better be tolerated in uncertainty or explored in therapy.

Clients ask AI to predict outcomes, analyze social interactions, or confirm whether their thoughts are “normal.” And it makes sense: the short-term relief from a machine that is designed to reassure and lean toward certainty - even when it’s deeply not certain - is immense. The long-term consequence, however, is reinforcement of the belief that one cannot tolerate uncertainty and an increase in distress, not a decrease, over time.

Generative AI models are trained to be agreeable and helpful. As a result, they may struggle to distinguish between a straightforward request for information and ritualistic reassurance-seeking. This distinction is critical in the context of health anxiety, OCD, and GAD.

One recent study found that 13.1% of U.S. youths, representing approximately 5.4 million individuals, used generative AI for mental health advice, with higher rates of 22.2% among those 18 years and older. Of these 5.4 million users, 65.5% engaged at least monthly and 92.7% found the advice helpful (McBain et al., 2025). The accessibility and perceived helpfulness of AI make recognizing its potential function as a safety behavior even more important.

Functional Analysis: How AI Maintains Anxiety

In CBT we use something called a functional analysis, a structured way of answering: What keeps this problem going? By looking closely at what happens before, during, and after a behavior, we can work with our clients to create a problem-solving plan.

Consider this chain:

Trigger: An intrusive thought arises, such as “What if I missed something important at work?” or “What if I accidentally hurt my child?” Anxiety spikes.

Behavior: The client asks AI for reassurance. They check facts, analyze a conversation, or confirm whether a behavior was acceptable. Sometimes they repeat the question in slightly different forms to get the answer they want.

Immediate consequence: Anxiety drops and temporary relief arrives. A sense of certainty follows.

Long-term consequence: Trust in internal judgment weakens while compulsive loops strengthen. Intolerance of uncertainty remains firmly in place.

That said, the behavior is negatively reinforced because the relief is immediate. When anxiety drops right after asking AI, the brain learns, “Great, that worked. Do that again.” However, the underlying fear is never fully processed, so it returns - and often stron ger.

Why CBT Therapists Should Take Notice

The rise of AI as a potential safety behavior has important implications for assessment. Therapists must ask not only about behaviors that occur in physical spaces, but also those occurring digitally. Clients may not view AI use as problematic. Often, they see it as helping with productivity or self-improvement. Without careful functional assessment, this maintaining variable can remain invisible.

AI is not inherently problematic, and information-seeking is not inherently compulsive. What matters is the function of the behavior. Is it expanding the client’s capacity and supporting their values? Or is it temporarily reducing distress while reinforcing the belief that uncertainty is intolerable and becoming part of the anxiety cycle?

Clinically impairing AI reassurance-seeking, on the other hand, often has recognizable markers:
Repetitive or looping questions framed slightly differently
Escalation under distress
Relief that is brief, followed by renewed doubt
Increasing reliance and decreasing trust in one’s own judgment
Avoidance of independent decision-making
Interference with functioning, relationships, or sleep

Another distinguishing feature is the absence of natural social friction. When reassurance is sought from friends or family, there are often limits, fatigue, pushback, or relational consequences that sometimes help interrupt the cycle.

Because of this, a client may be motivated not to ask their mom 100 questions on the same topic in one day. AI, on the other hand, has no such boundary. It is immediate, articulate, and endlessly available. That accessibility can make the reassurance loop more efficient and less visible.

AI reassurance-seeking can also be understood as a window into underlying core beliefs about competence and self-trust. When a client repeatedly needs to ask, “Did I handle that right?” the deeper belief may be, “I cannot trust my own judgment.” Identifying this belief creates an opportunity for guided discovery alongside exposure. Rather than simply removing the behavior, therapy can become an exploration of the belief system maintaining it.

This cycle mirrors classic reassurance-seeking in OCD (Abramowitz et al., 2009), so while the format is modern, the mechanism is not. To make it even more complicated, the accessibility and reassurance-giving design of AI itself has made avoidance of uncertainty more efficient than ever.

Integrating AI Use into CBT

The good news: once identified, AI behaviors can be incorporated into CBT.
Let’s look at an example using Exposure and Response Prevention (ERP) . ERP is a type of CBT that involves intentionally facing feared thoughts or situations while resisting safety behaviors. Over time, anxiety rises and falls naturally, and new learning occurs.

In practice, this might mean helping a client refrain from turning to AI when a trigger arises. Early steps could include delaying the question, setting limits around frequency, or asking once without rephrasing the question to chase a more reassuring answer. The goal is not to eliminate technology, but to interrupt the reassurance loop.

For example, a client who compulsively checks social cues might feel the urge to ask AI to predict how a conversation will go. Exposure work could involve resisting that prediction altogether, or asking once and then intentionally choosing not to adjust, rehearse, or overcorrect their behavior based on the response.

Rather than issuing directives, a CBT therapist relies on collaborative empiricism. Instead of saying, “Stop asking,” we might ask: What happened to your anxiety after you asked? What happened the next day? How long did the relief last?

Clients are then invited to examine the data of their own experience. Through guided discovery, they begin to see the pattern themselves. The principles remain unchanged: identify the fear, approach uncertainty, allow anxiety to rise and fall, and resist safety behaviors. The medium has evolved, yes, but the learning mechanism has not.

Moving Forward: CBT in a Digital Age

AI platforms have opened remarkable opportunities for learning and problem-solving. They have also introduced a new arena for reassurance-seeking and compulsive checking.

Our task is not to pathologize technology, but to assess its function. When viewed through a CBT lens, AI use simply becomes another behavior to understand. By identifying when it serves avoidance rather than growth, therapists can help clients step out of digital reassurance loops, rebuild trust in their own judgment, and practice tolerating uncertainty in a world that increasingly promises instant answers.

References

Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder. The Lancet , 374(9688), 491–499.

McBain, R. K., Bozick, R., Diliberti, M., et al. (2025). Use of generative AI for mental health advice among U.S. adolescents and young adults. JAMA Network Open .

Learn more about Melissa Harrison’s book:

Comorbid Eating Disorders and Obsessive-Compulsive Disorder: A Clinician’s Guide to Challenges in Treatment

https://www.amazon.com/dp/1009186876

Or visit her practice: www.centerforhopeandhealth.com

Watch Melissa and Katy Manetta, PhD talk about AI and CBT here:

Religiosity/Scrupulosity OCD in Judeo-Christian Contexts

Tue, 17 Feb 2026 16:58:27 GMT

From the perspective of Dr. Curtis Hsia, a psychologist and a practicing Christian

Obsessive Compulsive Disorder is based upon a person’s fear of a catastrophic outcome and desperate attempts to avert that outcome. This typically revolves around a concept that is central to a person, such as one’s relationship with their parents or spouse. We’re going to discuss another core area today: one’s relationship with God.

Often described as Religiosity or Scrupulosity OCD, this variation emphasizes offending God and/or ruining one’s relationship with God. We are going to focus today specifically on Judeo-Christian belief systems and how OCD often affects those with this faith background.

We often get referrals for religious OCD, and in particular for Christians. Understanding the basics of the theology and practice of a patient’s faith is crucial to differentiate what is a commonly acceptable belief and practice within the church or synagogue and what is more likely to be an obsession or compulsion.

Those who fall into the Judeo-Christian grouping would include individuals of Jewish, Catholic, and Protestant faiths. Broadly speaking, this can also include Latter-day Saints (Mormons), Seventh-day Adventists, and other related groups. They would agree that there is one God, and He (used not necessarily to denote gender, but traditionally to reflect power and strength) is omnipotent, omniscient, just, and good. There are theological distinctives as well—for example, the Christian focus on the deity of Christ and salvation through faith, Judaism’s lesser emphasis on heaven, and Catholicism’s elevation of tradition alongside Scripture—as well as important cultural differences.

Beyond Denomination: Understanding the Individual

What is important is not only which denomination one belongs to (e.g., an Orthodox Jew would have a very different view on what is kosher than one who is Reform), but also how important their faith is and how it affects their life. For example, I have had people state they are Christians because their parents are, yet they don’t attend church, haven’t read the Bible, and don’t hold to Christian values. Conversely, I have had OCD patients say they are not Christians despite engaging in and believing all of the above because they feel guilty about sinning. Much like acculturation and ethnicity, knowing one’s background is necessary, but it is just as important to understand the individual.

Religious obsessional thinking can vary, as can the resulting compulsions. Most center either on having a theologically inappropriate thought (“I hate God”) and engaging in compulsions to negate that thought (saying three times, “I love God,” looking up Biblical verses on love), or on feeling that one’s behavior carries unintended meaning that must then be corrected with a compulsion (“I didn’t do that prayer right, which indicates to God that I don’t love Him enough to do it correctly, so I need to do it again until I get it right”).

Evidence-Based Treatment for Religious OCD

So what’s to be done? Just like other variations of OCD, treatment follows a prescribed approach based on what research shows to be efficacious. Treatment usually begins with a thorough assessment to understand not only which disorders an individual meets criteria for, but also how the symptoms function for that person (e.g., Is the depression secondary to the OCD? Even if the OCD is addressed, will the depression remain? How much insight does the individual have about their obsessional thinking? How does the person’s family help or hinder treatment?).

Once the issues have been established, a treatment plan specific to that individual is constructed, based on Cognitive Behavioral Therapy with an emphasis on Exposure and Response Prevention. Psychoeducation is imperative, followed by cognitive countering (“Where’s the evidence that God would hate you if you didn’t say ‘I love God’ in just the right way? Where in the Bible does it state how many times you have to say ‘I love God’?”). Once the patient agrees intellectually that their obsessional thinking patterns are not theologically sound, we then engage in exposure. This can range from mild (saying “I love you” with the wrong cadence or emphasis), to moderate (stating “God is ok”), to more severe (saying “I hate God”).

When Theology and OCD Intersect

While this seems straightforward, the devil is in the details. The clinician must understand what is acceptable within the patient’s faith, or perhaps even their specific congregation. Some faith traditions, such as Judaism, require prayers to be said in a very specific manner. Conversely, this can lead to compulsive behaviors that are OCD-based (reducing anxiety about doing it “right”) as opposed to engaging in the practice for the glory of God and experiencing appropriate spiritual meaning when done correctly. It is not uncommon to obtain a release of information to consult with a patient’s pastor or rabbi to clarify what is appropriate (though this, too, can become a fine line if it turns into reassurance seeking).

One should remember that religious OCD is, in many ways, no different than any other variety. It is less about the content area and more about OCD attacking a construct the patient holds as valuable: family, safety of others, and in this case, one’s relationship with God. It’s not about theology; it’s OCD about one’s theology (the issue isn’t the issue—the underlying thinking pattern is). While this can be hard to remember at times, it can also bring relief: it’s not that God doesn’t love me, nor that I don’t love God. Rather, I love Him so much, and my faith is so central to me, that this becomes an easy target for OCD to attack—and there is solid science guiding how to treat it.

About the author: Dr. Curtis Hsia is a leading expert in the treatment of OCD and anxiety-related disorders, bringing decades of specialized training and clinical experience to his practice at the OC Anxiety Center. He earned his undergraduate degree in psychology from UCLA and went on to complete his doctoral degree in combined clinical and school psychology at Hofstra University. Dr. Hsia trained directly under pioneering OCD researchers Dr. Neziroglu and Dr. Yaryura-Tobias, where he developed deep expertise in Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP). He further refined his skills as a postdoctoral fellow under Dr. David Barlow at Boston University's Center for Anxiety and Related Disorders — one of the most prestigious anxiety research centers in the country.

Highlighting Mental Imagery in CBT

Sun, 25 Jan 2026 17:22:24 GMT

By Professor Emily A Holmes

Department of Women’s and Children’s Health, Uppsala University, Sweden

School of Psychology, University of Southampton, UK

My work concerns the science and practice of imagery-based cognitive therapy , as well as new techniques developed in reference to trauma memories and bipolar disorder.

The Science of Mental Imagery

Mental imagery occurs when we see in our mind’s eye or hear with our mind’s ear, and so forth. It is a wonderful human ability that allows us to visualize the future and recall past experiences (such as our last holiday). However, if the content of our mental imagery is negative and unwanted, it can be associated with psychopathology.

From a cognitive science perspective, mental imagery involves an experience like perception in the absence of a percept: seeing in our mind’s eye, hearing in our mind’s ear, for example. Mental imagery has extremely interesting properties – when we imagine, we use similar brain areas to actual perception, and our experimental work has shown that imagery feels “more real” than verbal thought. Mental imagery also enhances memory and learning. Critically for CBT, we now know that mental imagery acts like an “emotional amplifier”. Through a series of experiments, we were able to demonstrate that mental imagery has a more powerful impact on emotion compared to verbal processing.

Clinical Implications of Mental Imagery

From a clinical practice perspective, intrusive, affect-laden images cause distress across psychological disorders. Imagery-based intrusive memories and “flashbacks” to a past trauma are the hallmark of post-traumatic stress disorder (PTSD). Intrusive mental imagery can also occur of the future. We coined the term “flashforwards” to describe future-oriented mental imagery of suicidal acts or fueling manic pursuits in bipolar disorder. Thus, intrusive emotional imagery is transdiagnostic, occurring not only in PTSD and suicidality but across a wide range of psychological difficulties, including bipolar disorder, depression, OCD, panic, addiction, pain, complicated grief, etc. As we have learned from the science, compared to verbal thinking, mental imagery tends to feel more emotionally charged, more real, more immediate, and people are more likely to act on their imagery than verbal thoughts. This has important clinical implications. When distress is driven by imagery, such as intrusive memories, feared future scenes, or aversive moments replayed again and again, those images themselves (even if brief!) become important targets for assessment and treatment.

Assessment of Mental Imagery

Using imagery techniques is not a replacement for established cognitive–behavioral approaches, but rather a way of extending our clinical toolkits. In both research and clinical work, the best place to start is a detailed assessment of mental imagery associated with a given presenting problem. It never ceases to amaze me how mental imagery can be so fleeting (just 200 milliseconds!) yet still have such a powerful impact on us (but then so would a tiger with big teeth if you saw it for 200 milliseconds!). Perhaps because it is often so brief, it is easy to underestimate how much it might be affecting us. Key to an assessment is slowing down and providing an understandable definition of mental imagery compared to verbal thinking. Another reason clients might not spontaneously report imagery is that it might feel real, so again a careful definition and thoughtful explanation can be valuable. Thus, assessment involves clarifying what is meant by mental imagery, gaining a broad sense of the types and frequency of images experienced, and collaboratively identifying a particularly clinically salient image for focused work.

Micro-Formulation: Treatment for Troublesome Imagery

The next step after ascertaining whether someone has mental imagery and what it is of, we have called ‘micro-formulation’. This is a technique in which we use a visual template (available for free on my book website: https://www.cms.guilford.com/holmes-forms) to place a brief description of the image in the centre, and then collaboratively map out the associated emotions, appraisal, and the power of that particular image in quite some detail. This methodical assessment approach, which illuminates the impact a specific image can have, is often described by clients as particularly helpful.

The imagery micro-formulation also helps us select a rationale for treatment techniques, many of which will already be in our existing CBT toolkit! For example, if the power of a given image over someone is that it feels real and that it might really happen (let’s continue with the previous example, say a mental image of a large striped tiger walking into the room!) then this could be challenged by a behavioral experiment. Indeed, many techniques to work with troublesome imagery are as part of our CBT toolkit, such as behavioral experiments, Socratic dialogue, meta-cognitive techniques, etc. There are also imagery-specific techniques such as imagery rescripting, which is gaining increasing popularity in CBT and can be done in several ways. One relatively straightforward way to do imagery rescripting we have described in our 2019 book, listed below.

T he Imagery-Competing Task Intervention (ICTI): A Novel Treatment Approach

What if we could create a brief and gentle way to stop a trauma memory from flashing back? By focusing on the perceptual nature of imagery, we sought to find a mechanism to stop unwanted images coming to mind. For the last two decades, I have worked on the development of a novel intervention approach—the idea of dampening down intrusive mental images of trauma using a visuospatial concurrent task after recall. That is, to develop a brief treatment technique which targets image “intrusiveness” rather than the content of the image per se. It is a fairly brief technique, that can be used for one image at a time and as it is imagery-focused does not require clients to talk about their trauma in detail. In what you are about to read, this may sound like a strange intervention (with a game!), but CBT has a history of creative evolution. And please note, just playing Tetris® alone will not work!

The Imagery-Competing Task Intervention (ICTI) is designed to both (a) prevent the occurrence of unwanted intrusive memories shortly after a traumatic event, and (b) reduce the frequency of established intrusive memories over longer intervals—days, weeks, and months post-trauma. ICTI involves at least 3 steps: (i) brief imagery recall, (ii) mental rotation and (iii) sustained visuospatial task such as Tetris® computer gameplay.

Brief imagery recall, in which the client gently brings to mind a specific intrusive memory hotspot for a few seconds and labels it succinctly using perceptual descriptors (e.g., “red car,” “blue ambulance lights”);
Mental rotation, whereby the client engages their visuospatial working memory by actively manipulating objects in the mind’s eye (such as rotating and positioning shapes), which is done in conjunction with
A sustained visuospatial task (approximately 20 minutes), most commonly in our research we have used Tetris®, which places continuous demand on visuospatial processing while using mental rotation on planning the placement of the upcoming blocks. This is intended to interfere with the vivid, image-based processing of the memory, thereby reducing the likelihood of subsequent intrusive re-experiencing.

As said, it’s important to note just playing Tetris® alone will not work! The “devil is in the details” as research has time and again demonstrated that clients need a single guided session on how they can log and track their intrusive memories, as well as understand how to successfully utilize mental rotation. It’s also critical to log the occurrence of intrusive memories and capture their reduction. In our RCTs we have done this in a digital platform, so the timings and instructions are exact. We are next working on how to make the digital device available - a hope is that clinicians could guide a client through the digital platform (as we do in our research trials), after which then client can use it self-guided to treat their intrusive memories.

In the last 2 years we now have three recent randomized clinical trials of a remotely delivered version of the ICTI intervention for healthcare staff who had repeated and ongoing trauma exposure working with COVID-19 patients. Overall, results show that intrusive memories are reduced after a single guided session of ICTI digital platform. Indeed, for most participants, their intrusive memories reduce considerably after just one session. Further, there is a domino effect benefiting other symptoms of post-traumatic stress disorder, see the references below.

Looking Forward: Mental Health Science

These experiences have also convinced me that CBT and mental health care will benefit from fundamental innovations from science and that this is possible. With Michelle Craske, I contributed to an international call that was published in Nature which urged the field to unite under the umbrella term of “mental health science” through integrating interdisciplinary scientific insights and technological advances. Later, I helped lead a commission published in The Lancet Psychiatry on the future of psychological treatment research. That evolution will require not only our clinical expertise in CBT, but collaboration between disciplines, from artists to neuroscientists.

The Power of Imagery

Mental imagery can shape how we remember, how we feel, how we plan, and how we anticipate. Mental images can trap people in trauma or point toward recovery. When we work with imagery directly, we engage the brain’s most powerful emotional-behavioral systems. I hope reading this has left you with a curiosity about mental imagery and helped you imagine how different sorts of imagery techniques could be applied as part of our wider CBT toolkits going forwards.

Want to learn more? Check out the conversation with the author and Dr. Katy Manetta here.

References

Books

Hackmann, A., Bennett-Levy, J. & Holmes, E. A. (2011). Oxford Guide to Imagery in Cognitive Therapy. Oxford: Oxford University Press. ISBN: 978-0-19-923402-8. https://global.oup.com/academic/product/oxford-guide-to-imagery-in-cognitive-therapy-9780199234028?cc=se&lang=en&

Holmes, E. A., Hales, S. A., Young, K., Di Simplicio, M. (2019) Imagery-Based Cognitive Therapy for Bipolar Disorder and Mood Instability. New York: Guilford Press. ISBN 9781462539055. Imagery-Based Cognitive Therapy for Bipolar Disorder and Mood Instability https://www.guilford.com/books/Imagery-Based-Cognitive-Therapy-Bipolar-Disorder-Mood-Instability/Holmes-Hales-Young-Simplicio/9781462539055?srsltid=AfmBOoo_3pL8VDJU5dD35oHr0aMrStuiPpW12m2uHuqpy5_RyLOpyiN9 and materials: https://www.cms.guilford.com/holmes-forms

Publications

Holmes, E. A., & Mathews, A. (2005). Mental imagery and emotion: a special relationship? Emotion, 5(4), 489-497. https://doi.org/10.1037/1528-3542.5.4.489

Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). A call for mental-health science. Clinicians and neuroscientists must work together to understand and improve psychological treatments [Comment]. Nature , 511(7509), 287-289. https://doi.org/10.1038/511287a

Ji, J. L., Burnett Heyes, S., MacLeod, C., & Holmes, E. A. (2016). Emotional mental imagery as simulation of reality: fear and beyond – a tribute to Peter Lang. Behavior Therapy , 47(5), 702-719. https://doi.org/10.1016/j.beth.2015.11.004 in Special 50th Anniversary of AACBT Issue : Honoring the Past and Looking to the Future: Updates on Seminal Behavior Therapy Publications on Etiology and Mechanisms of Change

Holmes, E. A., Ghaderi, A., Harmer, C., Ramchandani, P. G., Cuijpers, P., Morrison, A. P., Roiser, J. P., Bockting, C. L. H., O’Connor, R. C., Shafran, R., Moulds, M. L., & Craske, M. G. (2018). The Lancet Psychiatry Commission on Psychological Treatments Research in Tomorrow’s Science. Lancet Psychiatry , 5(3), 237-86. https://doi.org/10.1016/S2215-0366(17)30513-8

Iyadurai, L., Highfield, J., Kanstrup, M., Markham, A., Ramineni, V., Guo, B., Jaki, T., Kingslake, J., Goodwin, G.M., Summers, C., Bonsall, M.B., & Holmes, E. A. (2023). Reducing intrusive memories after trauma via an imagery-competing task intervention in COVID-19 intensive care staff: a randomized controlled trial. Translational Psychiatry , 13(1), 290. https://doi.org/10.1038/s41398-023-02578-0

Highfield, J., Iyadurai, L. & Holmes, E.A., (2025). A summary review of the development of using a brief imagery-competing task intervention (ICTI) for reducing intrusive memories of psychological trauma: applications in healthcare settings for both staff and patients. Discover Mental Health . 5, 78. https://doi.org/10.1007/s44192-025-00205-6

Beckenstrom A.C., Bonsall, M.B., Markham, A., Slade, O., Ramineni, V., Iyadurai, L., Islam, Z., Highfield, J., Jaki, T., Goodwin, G.M., Dias, R., Daniels, R., Malik, A., Summers C, Kingslake, J., Holmes, E.A. (2025). A randomised controlled trial of a brief cognitive task intervention to support NHS staff experiencing intrusive memories of traumatic events from working in the COVID-19 pandemic: the GAINS-02 study, the Lancet Psychiatry [In press]

Disclosure
Current funding from Wellcome Leap, and the Swedish Research Council (Vetenskapsrådet)
Board member of MQ Foundation - https://mqfoundation.com

For more information about Emily and her research, please visit www.emilyholmes.net

CBT in the Arab World: Cultivating Learning, Practice, and Transformation

Mon, 15 Dec 2025 19:15:37 GMT

A Personal and Professional Journey

My initial encounter with cognitive behavioral therapy (CBT) was simply an academic exploration of one therapeutic approach among many. However, this academic interest quickly evolved into a profound personal and professional calling, powerfully shaping my career and ultimately sparking a movement for psychotherapy education across the Arab world.

During my second year of university, I was introduced to CBT. At the time, I was deeply drawn to Carl Rogers and the humanistic tradition, with its emphasis on empathy, relational depth, and the inherent potential for growth. Yet, Aaron Beck’s cognitive model, with its elegant and practical connection between thoughts, emotions, and behaviors, resonated deeply within me. I recognized it not merely as a theory, but as a practical tool for living, something that could be applied, shared, and taught.

As someone dedicated to mental health, I didn’t just study CBT; I actively integrated its principles into my own life. It wasn't an academic exercise, but a method to navigate challenges, alleviate self-doubt, and modify unhelpful beliefs with curiosity rather than judgment. This experience was transformative, instilling a profound sense of clarity and responsibility: I knew I needed to bring this back home.

"Home" encompassed not only a physical location but also a cultural and linguistic landscape. In Lebanon and the wider Arab world, psychotherapy education has historically been heavily influenced by Western thought. While theories and approaches have been translated and adapted, much has been lost in this process, both literally and culturally. Concepts often arrived in our region devoid of the lived experience and language that would allow them to truly resonate.

I identified significant gaps in accessibility, linguistic familiarity, and cultural relevance. While I witnessed immense passion among students and clinicians, structural support for training was limited. Yet, I also saw enormous potential, waiting for the right structure, community, and language to be fully realized.

This is where my journey truly began.

The Genesis of CBT Study Groups: Addressing Need and Opportunity

In early 2020, as the COVID-19 pandemic imposed global isolation, it simultaneously opened new avenues for connection. Online learning transitioned from a novelty to a necessity. I recognized an opportunity not just to teach CBT, but to foster a collaborative learning environment.

Thus, the first CBT Study Group was formed.

It started simply: six participants from diverse backgrounds, each week bringing their curiosity and eagerness. Our group comprised psychology students, early-career therapists, and individuals from other professions drawn to CBT. Together, for six months, we committed to weekly reading, meetings, sharing, questioning, and practicing.

The structure was deliberate: flexible yet anchored. Each session included a review of the week’s readings, guided discussions, role-plays with constructive feedback, and dedicated space for personal reflection. The group's unique spirit—collaborative, open, emotionally grounded, and deeply human—truly set it apart.

CBT transcended mere academic study, becoming a way of life.

That initial group led to a second, and then a third. Over the months and years, the CBT Study Group evolved from a singular entity into a vibrant community of practice, now encompassing:

21 Level 1 cohorts
5 Level 2 cohorts
A Level 3 cohort

Over 150 participants from across the Arab region.

These study groups were not formal training programs but rather a gateway to CBT, a safe and structured transitional space for individuals to explore whether CBT was truly their chosen path. Many subsequently pursued full certification with international institutions. Others confidently began integrating CBT into their clinical practice with greater depth.

The movement's growth was driven not by marketing, but by meaning. It flourished through word-of-mouth, trust, and authenticity. People joined seeking not just knowledge, but guidance, space, and meaningful conversation. They yearned to feel understood in their learning journey and connected in their personal and professional growth.

Crucially, they desired to experience CBT in a way that authentically reflected their culture, language, and lived realities.

A Transformational Space: The Impact of the Study Groups

Over time, the CBT Study Groups evolved beyond a series of learning opportunities. They became a shared experience of conceptualizing, articulating, learning, and practicing therapy in Arabic—and with direct relevance to our lives as Arabs.

Participants came from diverse backgrounds: some were pursuing psychology degrees, others were licensed clinicians seeking structure and mentorship, and some hailed from entirely different disciplines, driven by a personal need for understanding and healing.

What united them was not a shared identity, but a common aspiration: to learn CBT not just as a therapy, but as a process of personal growth.

Almost every participant expressed sentiments similar to: "I didn’t realize that learning CBT would change not just my work, but my life."

Each time I received such feedback, I was reminded that when therapy education is grounded in conversation, reflection, and cultural resonance, it transcends mere skill acquisition and becomes an integral part of who we are.

The study groups empowered participants to:

Acquire solid foundational knowledge in CBT theory.
Enhance client work through structured case conceptualization.
Develop confidence in role-plays and interventions.
Feel connected to a regional community of learners.
Prepare for formal and certified CBT training programs.

The transformation extended beyond cognitive understanding; it was relational, emotional, and practical. Many participants described the study groups as "safe," "grounding," and "hopeful." For some, these weekly meetings became a vital support system during times of distress, uncertainty, or crisis.

This profound impact matters, not only because supported learning is more effective, but because it fundamentally alters how therapists engage with their clients.

These study groups fostered a sense of collegiality among students, built interpersonal trust into the learning process, and helped a generation of Arab practitioners see themselves as integral to a global movement, with their own distinct voice and value.

That voice became even clearer the day I began writing the first Arabic guide to learning CBT.

A Book with Arab Identity: Crafting A CBT Manual in Arabic

Writing دليل تعلم العلاج المعرفي السلوكي (Guide to Learning CBT) was a decision I made with careful consideration. It emerged organically from the study group experience and the pressing need for a culturally relevant and structurally organized manual in Arabic.

The book originated as notes, reflections, and exercises shared with study group participants, but it quickly became evident that something more substantial was required. Not merely a translation of Western CBT manuals, but an original text: one rooted in our specific context, grounded in the Arabic language, and fueled by years of collective learning.

Its creation spanned several years, a period marked by:

Training in ACT, DBT, Schema Therapy, REBT, CFT, MI, SFBT, and CPT.
Navigating national financial collapse.
Continuing clinical work during and after the Beirut blast.
Supporting learners amidst war and displacement.
Rewriting content to maintain relevance with real-life examples and daily experiences.
Translating psychological concepts in a way that resonated authentically in Arabic.

Both the challenge and the reward lay in the same element: language.

Arabic is poetic, multi-layered, emotionally rich, and abundant in metaphor. Expressing clinical concepts with both scientific precision and cultural resonance demanded creativity, extensive revision, humility, and courage.

And it proved successful.

Upon the book's release, readers from Lebanon and beyond reached out, sharing that they finally felt CBT was "theirs" not something borrowed or foreign, but something familiar, useful, and profoundly meaningful.

That was the moment I realized the profound significance of this work: not because I had simply written a book, but because something important was being claimed: a space for CBT in Arabic, not as a translation or imitation, but as an act of ownership and a genuine contribution.

The Cultural Bridge: Why CBT Resonates in the Arab World

Many inquire: "Does CBT even work in Arab culture?"

My consistent response is: CBT works wherever there are humans.

CBT resonates within the Arab world not because it requires adaptation, but because it inherently aligns with our values, such as reflection, meaning-making, deep contemplation of suffering, and the honoring of family, community, and resilience.

The misconception that CBT is "surface-level" quickly dissipates once individuals experience its full depth, exploring core beliefs, identity wounds, trauma patterns, existential evaluations, and the narratives we construct when feeling isolated or misunderstood.

CBT offers more than just an approach; it provides a pathway. A structured way to understand pain, respond to it, and forge meaning despite it.

To achieve this responsibly, two elements are essential:

Scientific integrity
Cultural sensitivity

Because treatment is designed to help people and not the other way around.

Looking Ahead: A Collective Mission for the Future

Today, my work continues through:

Coordinating and expanding the CBT Study Groups.
Offering free public webinars and introductory workshops to reduce barriers to access.
Writing additional Arabic materials to support learning and outreach.
Developing Arabic video content on CBT concepts and tools.
Supporting Arab clinicians in pursuing international CBT certifications.

However, the most exhilarating aspect of this journey is this:

The next generation has arrived.

They are advancing this work further: becoming certified clinicians, trainers, and advocates for psychotherapy within their respective countries and communities.

They will achieve things I have not. They will expand, teach, supervise, research, publish, and establish structures that none of us grew up with.

My aspiration is not to lead them, but to journey alongside them, not as the sole expert, but as a colleague, mentor, and fellow human being.

If this work leaves a legacy, let it be this:

That we created spaces where people could learn therapy in their own language.

That we trusted psychology to develop its own Arab identity, rather than merely borrowing from elsewhere.

That we approached education as a community endeavor, not a competition.

That we maintained belief in meaning, even amidst crisis.

And that we never forgot the simplest truth:

Hand in hand, we build a better world.

Paul Kawkabany, BICBT-CC, A-CBT

Licensed Clinical Psychologist and Psychotherapist

Beck Institute CBT Certified Clinician BICBT-CC

Diplomate of the Academy of Cognitive and Behavioral Therapies A-CBT

Dr. Lata McGinn Receives the Lifetime Achievement Award in CBT

Mon, 01 Dec 2025 15:58:41 GMT

On November 20th, 2025 Dr. Lata McGinn was awarded the Lifetime Achievement Award by the Academy of Cognitive and Behavioral Therapies (A-CBT) at the Awards ceremony held at the ABCT annual conference in New Orleans, Louisiana.

T he Lifetime Achievement Award is the most prestigious honor in Cognitive & Behavioral Therapies. Presented annually by the Academy of CBT, it recognizes an individual who has made significant and enduring contributions to the field. The Lifetime Achievement Award Nomination and Selection Committee is composed of all past presidents of the Academy of CBT as well as all previous recipients of the Lifetime Achievement award. The committee solicits nominations each year and then narrows the list to five finalists and selects the winner.

This distinguished honor recognizes Dr. Lata McGinn’s visionary leadership, her excellence in research, clinical practice, and training and her transformative impact on the development, implementation, and global dissemination of evidence-based psychological treatments. Through her pioneering research, training, clinical innovation, and strategic leadership, she has helped shape the modern landscape of cognitive and behavioral therapies worldwide.

Dr. McGinn has delivered over 360 presentations, including peer reviewed conference presentations, invited keynotes, master clinician seminars, and workshops, and has authored or co-authored over 80 publications, including peer reviewed journal articles, chapters, and two books. Dr, McGinn has developed the Unified Vulnerability Model and innovative CBT preventative and treatment interventions in the areas of anxiety, depression, OCD, and PTSD such as the Mind-Action-Mood Program and Psychological First Aid Plus that have been implemented into schools and colleges in the United States and are being implemented in South America. Her co-authored books—Treatment of Obsessive-Compulsive Disorder and Treatment Plans and Interventions for Depression and Anxiety Disorders (which has been translated into 14 languages) and are used internationally by clinicians and trainees and as texts in graduate departments of clinical psychology.

As a tenured full professor at Yeshiva University, she fundamentally reshaped its clinical program at Ferkauf Graduate school of Psychology, establishing the intensive, evidence-based model it is today. Over the 20 years she served as the Director of the clinical program, Dr. McGinn designed a comprehensive training infrastructure and processes rooted in scientific principles and recruited a faculty distinguished by expertise in research in evidence-based practice. She also founded the CBT training program at the graduate school, which has trained over 250 students since its inception and is notable for its rigorous emphasis on theory, research, clinical application and competency. She has also taught the advanced CBT courses to doctoral students over the past 25 years and founded the low-cost CBT university clinic in the Bronx in 2000, which has served and expanded access to high-quality evidence-based mental health care for over 1500 residents of the poorest county in the United States to date, and to date has served more than 1500 patients.

Equally significant, Dr. McGinn co-founded Cognitive and Behavioral Consultants (CBC) in 2004 with Dr. Alec Miller, advancing a mission to disseminate high-fidelity, evidence-based mental health treatments and training while cultivating a warm, collaborative, intellectually rich practice and training environment for professionals and students. Together, they have brought together a team of over 30 expert clinicians who deliver CBT and DBT with outstanding treatment reliability and efficacy. Since 2004 , CBC colleagues have collectively served over 2000 clients, trained over 100 graduate and postdoctoral trainees, and trained professionals in over 150 schools, agencies and organizations.

Her leadership record is exceptional. She is a former president of the Academy of CBT and the International Association of Cognitive Behavioral Therapy, and was on the Board of Directors of the Association for Behavioral and Cognitive Therapies (ABCT) and continues today in ABCT’s governance. She has founded, co-founded and guided others to found evidence-based organizations locally, regionally, and across the world to disseminate evidence-based psychological treatments, especially for underserved areas and peoples of the world. She is a Co-Founder and Vice President of the Access Psychology Foundation (APF), a founding fellow and trainer consultant of the Academy of CBT, the New York CBT Association, the Indian Association of CBT. She also spearheaded the global initiative to found the World Confederation of Cognitive and Behavioral Therapies (WCCBT) in 2019.

Underscoring her global influence and continuing role in shaping the field’s future, Dr. Lata McGinn Dr. McGinn is the president of the World Confederation of Cognitive and Behavioral Therapies (WCCBT) and in that capacity, works with local, national, and regional organizations across the Americas, Europe, Asia, Australasia, and Africa as well as with Global organizations like the World Health Organization and Governments to increase access to evidence-based mental health treatments, In this capacity, she has guided professionals in underserved regions of the world such as Asia and Africa to build CBT organizations in order to increase workforce capacity and access to evidence-based mental health therapies.

Over more than three decades, Dr. McGinn has elevated the field of clinical psychology through her training, research, and clinical practice, through her local, national, and global capacity building and leadership and through her influence, inspiration and guidance to hundreds of students, trainees, and psychologists. Her legacy is defined not only by her innovative research, training and clinical achievements but by her enduring achievements in disseminating cognitive and behavioral therapies locally, regionally, and worldwide and by her impact in cultivating the next generation of leaders in evidence-based mental health.

Please join us in congratulating Dr. Lata K. McGinn on this richly deserved recognition honoring her exceptional achievement, leadership, and vision in transforming lives through cognitive and behavioral therapies.

Advances in CBT Newsletter - Fall 2025

Mon, 17 Nov 2025 18:42:40 GMT

Fall 2025

The Fall 2025 issue of Advances in CBT is now available. This edition features key updates from both the Academy and the International Association of Cognitive Behavioral Therapy, along with new initiatives, member achievements, and upcoming opportunities to engage with our community.

Highlights include:

A message from A-CBT President Dr. Jamie Schumpf, reflecting on organizational growth, new membership pathways, and global training efforts.

Details on our Annual Reception in New Orleans and this year’s award recognitions.

The launch of the A-CBT Blog and Author Spotlight Series, showcasing thought leadership from our diplomates and fellows.

Updates on ongoing web-based trainings, including our foundational Introduction to CBT course.

Information about the monthly peer-consultation group, open to all members.

Member and community features spotlighting current work, international initiatives, and evolving directions in CBT practice.

Recent publications from the International Journal of Cognitive Behavioral Therapy.

We encourage you to read the full issue for articles, announcements, and ways to stay connected with Academy and IACBT activities.

Thank you for your continued commitment to advancing high-quality CBT around the world!

We also invite submissions for future issues of Advances in CBT, including brief articles, clinical reflections, and updates on CBT-related initiatives around the world. If you are interested in contributing, please contact Editor Dr. Scott Waltman at walt2155@pacificu.edu

Shame: The Oft-Neglected Target in CBT for Social Anxiety

Fri, 14 Nov 2025 18:34:26 GMT

Shame: The Oft-Neglected Target in CBT for Social Anxiety

Written by Larry Cohen, LICSW, A-CBT

[This article is adapted from chapter 1 of Overcoming Shame-Based Social Anxiety and Shyness: A CBT Workbook by this author.]

More Than a Phobia

Most self-help books about social anxiety disorder (SAD)—and some therapist manuals, as well—focus almost entirely on helping people overcome the severe impact that anxiety has had on their lives. This restricted approach is usually greatly beneficial. But, for the large majority of sufferers, social anxiety disorder, often called social phobia, is more than a simple phobia: an exaggerated and life-restricting fear. Unlike all other phobias, social anxiety disorder is usually based on shame-generating core beliefs about fundamental personal deficiency and perfectionistic self-expectations, which in turn lead to the exaggerated fear of judgment and rejection that is the hallmark of SAD. Shame is, for most people, a key ingredient in their social anxiety.

A phobia, of course, is an exaggerated fear or disgust about a type of situation, animal, or object that is so distressing that it makes it very difficult to pursue important life activities or goals. This is true of social anxiety disorder, too. Yet unlike all other phobias, SAD typically stems from distorted, negative, shame-based core beliefs about yourself and how you believe you are perceived by others: that you are deficient in some fundamental way(s) and are not good enough to be liked, respected, loved, or successful. Other phobias stem from distorted, negative beliefs about the feared situation, animal, or object.

In this way, social anxiety disorder is fundamentally different from all other phobias: negative core beliefs about yourself and the shame they induce are driving, causal factors of SAD for the vast majority of those who suffer from it. This is not true of other phobias.

Because of the fundamental role of shame in social anxiety disorder, strategies like traditional, habituation-oriented exposure therapy—the gold standard for treating other phobias—need to be adapted to also challenge and modify the core beliefs that cause so much shame, rumination and often depression. Outcome studies demonstrate that traditional exposure therapy is, indeed, quite effective in treating social anxiety disorder. But it is not as effective as when exposures are approached as behavioral experiments to test and challenge anxious thoughts, predictions and underlying beliefs about yourself, and how you are perceived by others.

Why is this true? One key reason is that anxiety habituates with exposure as you learn that your fears are greatly exaggerated, and that we can cope with them well. That is why exposure therapy is so effective for specific phobias. Unlike anxiety, shame does not habituate . You have to test and modify the beliefs that generate the shame in the first place in order to feel better about yourself and to gradually replace shame with self-confidence and pride.

Core Beliefs Generating Shame and Anxiety

Fundamental personal deficiency and perfectionist expectations about yourself are the most common themes of the core beliefs underlying social anxiety disorder. In addition, some SAD sufferers have core beliefs about the untrustworthiness of others. At their deepest level, many persons with SAD are troubled by absolute beliefs about self, about people in general, and about the way the world is or should be. Here are some examples of absolute core beliefs commonly underlying SAD:

— I’m socially inept and bad at meeting people.

— I’m fundamentally different and don’t fit in.

— I don’t measure up.

— I’m weird / not normal / not good enough.

— Others see me as weird and uninteresting.

— I should never offend or hurt anyone’s feelings, even unintentionally.

— People find me uninteresting / unattractive.

— Men / adults / attractive people can’t be trusted.

Also very important are conditional beliefs (often, but not always generated from absolute beliefs): if-then ideas about self, other people and the world. Common SAD examples of conditional beliefs include:

— If I make a social blunder, people will judge me harshly and reject me.

— If my anxiety or awkwardness shows, people will think I am weak or weird.

— If I displease or disagree with people, they’ll dislike me.

— In order to be accepted and liked, I must always meet others’ expectations of me.

— If people knew what I was really like, they would dislike me.

— If I get close or vulnerable to others, they’ll take advantage of me and hurt me.

It is not difficult to see how such core beliefs, be they absolute or conditional, generate both shame and anxiety, in addition to depression. In fact, the incidence of depression among persons with SAD is two to three times greater than that in the general public. For some SAD sufferers, their core beliefs are largely conditional, and so their shame and depression is largely generated by experiences in which they believe they have not met others’ expectations of them. For other SAD sufferers, their core beliefs are also absolute, often leading to chronic shame and depression.

SAD Facts

Social anxiety disorder exists when the fear of judgment (including criticism, rejection, scrutiny, and embarrassment) makes it extremely difficult to pursue one or more major life activities and goals, such as socializing, friendships, romantic relationships, advancing your career, speaking or otherwise performing in front of others, asserting yourself, using public bathrooms, being sexual, or even just being around others in a public place.

A momentary experience of social anxiety is completely normal, and in small measure, it is often helpful. It keeps you sensitive to the feelings and concerns of others and thereby allows relationships and society to function. (Only very arrogant or psychopathic people rarely experience momentary social anxiety, because the feelings of others have little value to them.) But the lives of people with SAD are debilitated by their repeated experiences of social anxiety, resulting in lessened social and recreational satisfaction; fewer friendships and romantic relationships; lessened likelihood of being married; less success in school and career; and/or a much greater likelihood of experiencing depression and alcohol use disorders.

Social anxiety disorder is the third or fourth most common mental health problem in the United States. Research shows that 12% of adults have experienced SAD during their lives; 7% have experienced it in the past year. The prevalence is even higher among adolescents, 9% of whom have suffered from SAD in the past year. Sadly, only 37% of people with social anxiety disorder recover naturally (without treatment) during their lifetimes. But the good news is that cognitive-behavioral therapy helps two thirds to three quarter of people overcome SAD.

The Vicious Cycle of Social Anxiety and Shame

The experience of social anxiety involves a vicious cycle fueled by core beliefs of fundamental personal deficiency and perfectionistic self-expectations, and sometimes the untrustworthiness of others. These beliefs generate hot thoughts (automatic thoughts) about conversing or performing badly and appearing anxious or foolish in situations where you fear your deficiencies may be exposed . These thoughts generate much anxiety , leading you to rely on safety-seeking behaviors in an effort to avoid making a bad impression. Examples of safety-seeking behaviors include: avoidance; self-monitoring and self-critiquing performance and appearance; scripting what to say next; keeping attention off yourself; and trying to hide your anxiety. But these safety-seeking behaviors backfire and actually hurt how you come across, converse, or perform: an unintentional self-fulfilling prophesy. Because of your negativity bias (i.e., a safety-seeking behavior in which you mainly focus on what you think may be going badly during an interaction), you believe you made a much worse impression than you actually did, which leads you to engage in self-critical rumination and worry after the triggering situation and before the next one. This, in turn, causes you to feel shame and reinforces your core beliefs of personal deficiency and perfectionistic self-expectations.

This vicious cycle is illustrated in the following diagram:

Let’s take a close look at two common examples of social anxiety to see how this vicious cycle plays out. I commonly discuss one of these examples in the first or second session with a socially anxious client, using specific examples of the client’s own situational triggers, hot thoughts, core beliefs and safety-seeking behaviors.

Mingling with Strangers

Let’s say you’re invited to a party by a friendly coworker, Jason. You have a personal goal to make more friends, so you think that this party could be an opportunity to begin doing so. But you’re troubled by old core beliefs —seemingly supported by years of painful evidence—that you’re really bad at socializing and meeting new people; and if others see you appear anxious or screw up in the conversation, they’ll be turned off and think that you’re weird or uninteresting.

In the past, you’ve generally avoided social activities out of fear that your social deficiencies and anxiety would show, that others would react negatively to you, and that you would end up with feeling shame and depression. You’re very tempted to rely on your old safety-seeking behavior of avoidance this time, too. You spend a lot of time ruminating , worrying , and trying to figure out what to do. You consider telling Jason that you already have other plans that day. You think that Jason was just being nice in inviting you and doesn’t really care if you come.

You scold yourself with shame : “What’s the matter with me that I feel so anxious about going to a party?! Other people enjoy going to parties. Maybe this time will be different.” So you go.

After spending a lot of time worrying about what to wear, when to arrive, and whether you should come up with a last-minute excuse to not attend, you finally arrive at the party. With much anxiety , you quietly knock on the door and wait with mounting discomfort for what feels like a long time. You knock again, this time louder. Somebody answers the door, but it’s not someone you know. You manage to say that you’re here for Jason’s party, and that person lets you in but doesn’t introduce herself. You’re left standing just inside the door as you look around the large room and see that it’s crowded with people standing in small groups and actively chatting. You criticize yourself for not arriving earlier when there would have been fewer people. You’re trying to figure out what to do. You think about leaving, but you feel ashamed and criticize yourself for even thinking so.

You finally see Jason across the room, chatting and laughing away with people you don’t know. You can’t hear what they’re saying. You’re trying to decide what to do, but you’re troubled and frozen by anxious hot thoughts : “Should I go up to them and say hi, or would they think I’m intruding and being rude? Do others notice me standing alone so long, and are they thinking that I’m weird and unfriendly?” Then, to your surprise, Jason happens to turn a little. His eyes meet yours. He smiles and laughs. He turns back and continues laughing and chatting with his friends, who briefly glance your way, and then turn back.

You feel a surge of embarrassment. You have the hot thoughts that you’ve already made a terrible impression with Jason and his friends, who are probably saying negative things about you and even laughing at you. Your anxiety is increasing, and you’re thinking of just turning around and leaving, but feel too much shame for even considering that option. So you stay, take a deep breath, walk up to Jason, and timidly say hi to him and his friends.

They seem friendly enough. They try to make conversation with you, but you rely on your old safety-seeking behaviors of answering their questions in just a few words in order to get the attention off of yourself. You focus attention on your own anxious feelings and physical symptoms in a futile effort to control and hide them: your voice, which you think sounds horribly shaky with nervousness; your hands, which seem so jittery; and the warmth you feel in your face, which you imagine appears beet red. You also desperately try to script in your mind what to say next, and only come up with questions, again to keep the attention off of you. You criticize yourself for coming across so awkwardly. You end up just standing there quietly while Jason and his friends continue chatting, now ignoring you. Your safety-seeking behaviors backfire, making you appear uninterested and uninteresting to your conversational partners, who respond by saying very little to you. This fuels a self-fulfilling prophecy which you perceive as confirmation of your core beliefs about fundamental personal deficiency.

At some point you excuse yourself to go to the bathroom, where you spend time ruminating in self- criticism and feeling shame . After a prolonged escape in the bathroom—where you start feeling anxiety that others will think you’re weird for being there so long—you finally return to the party, grab a drink, and engage in other safety-seeking behaviors of standing off by the side, quickly averting eye contact with people, and looking at your phone a lot in order to appear busy. Again, these safety-seeking behaviors backfire and lead other to avoid you, thinking you’re unfriendly or uninterested.

The few times somebody does come up to try to talk to you, you rely on your other safety-seeking behaviors : speaking very briefly, focusing on your anxiety symptoms, and trying to script what to say next…all of which backfire, hurting the conversation and how the other persons perceives and responds to you. Each conversation is just as awkward and brief as the previous one. Your negativity bias kicks in, making you unaware that at least one person seemed to enjoy talking with you, and may even have been flirting with you. But by looking away and speaking only briefly, you came across as uninterested.

You finally sneak out of the party—too anxious and ashamed to say goodbye to anyone—and go home. There, off and on for weeks, you ruminate about how badly you think came across, feeling engulfed in shame about yourself and despair about your future. Your negativity bias keeps you stuck in self-criticism while disqualifying or ignoring the positive aspects of your attending the party. At work, you avoid or minimize interaction with Jason as much as possible out of fear of facing a negative reaction from him.

Speaking to a Group

Let’s say you’re at a meeting at work. Because you have the core belief that you’re fundamentally deficient at conversing in groups, and that others will judge you as weird and incompetent if they see you screw up or appear anxious in any way, you rely on the safety-seeking behavior of sitting silently and just listening to others speak in order to keep attention off yourself.

But then someone asks you a question and your anxiety surges. You now engage in the safety-seeking behavior of speaking very briefly, even though you have much more you could say, because you hate the attention, which you assume to be critical. You focus on your anxious symptoms in the hope that you can hide them from the examining eyes of others. When it’s your turn to present something, you focus on your notes or slides, reading them word for word rather than speaking freely, while avoiding looking at the audience. These safety-seeking behaviors backfire, hurting how you come across and what you say. Your negativity bias leads you to home in on someone who appears uninterested while not noticing others who look quite interested in what you’re saying. After the gathering, you ruminate in harsh self-criticism off and on for days, leaving you feeling deep shame , and setting yourself up to experience even more anxiety the next time you need to speak up in a group.

Breaking the Vicious Cycle

It doesn’t have to be this way! We can learn to break the vicious cycle and experience a positive, virtuous cycle instead. Imagine that you go to the party or speak at the group gathering with the core belief that you have strengths and weaknesses like everyone else, and that you don’t have to appear or perform perfectly for people to enjoy talking with you and be interested in what you have to say. Instead of relying on your safety-seeking behaviors, you focus your attention externally on what people are saying in the moment, and on expressing what pops into your mind naturally, without scripting. Instead of allowing negativity bias to lead to ruminating in self-criticism afterward, you pat yourself on your back for the positive things you did and the positive experiences you had during this interaction. You accept as completely normal that not every interaction will go ideally and that not everyone will like you, seeing that as just an indication that everyone has different preferences, not that you are deficient. Instead of feeling shame, you feel pride, self-confidence, and hopefulness for the future. Instead of worrying how the next interaction will go, you look forward to it as an opportunity for enjoyment and to move your life forward.

Integrative CBT

In addition to addressing both shame and and anxiety, my CBT for social anxiety workbook features an integrative CBT approach to SAD, bringing together the evidence-based strategies from all three “waves” of cognitive behavioral therapy. From first-wave (behaviorally focused) CBT, I emphasize exposure therapy while eliminating unhelpful safety-seeking behaviors and building confidence in your social skills. From second-wave (cognitively focused) CBT, I emphasize behavioral experiments designed to test and change anxious hot thoughts and underlying shame-based core beliefs, as well as strategies to reframe your thinking to lessen anxiety and avoidance, and to build confidence and pride. We also incorporate assertive defense of the self strategies to enhance confidence in your ability to handle fears come true with a sense of dignity, rather than shame. Second-wave CBT has been demonstrated to be the most effective treatment for social anxiety disorder. From third-wave (mindfulness-based) CBT — including acceptance and commitment therapy, or ACT—I emphasize incorporating strategies to focus externally and with curiosity on the conversation, person and activity in the moment, and to defuse from your anxious thoughts and feelings while interacting.

Each of these strategies is discussed in depth, along with practice exercises and worksheets, in my recently published Overcoming Shame-Based Social Anxiety and Shyness: A CBT Workbook . It is designed for socially anxious individuals to use on their own, with friends or in support groups; or to used together with a CBT provider during psychotherapy.

Resources

National Social Anxiety Center website: with troves of information, training and CBT-certified referrals for both clinicians, as well as socially anxious consumers.

Self-scoring questionnaires to assess social anxiety (adults and children), including questionnaires for shame, and for sexual anxiety.

Free training webinars on CBT for social anxiety.

Reference

Mayo-Wilson, E., S. Dias, I. Mavranezouli, K. Kew, D. Clark, A. Ades, and S. Pilling. 2014. “Psychological and Pharmacological Interventions for Social Anxiety Disorder in Adults: A Systematic Review and Network Meta-analysis.” Lancet Psychiatry 1: 368–76.

About the Author

Larry Cohen, LICSW, A-CBT, is cofounder and Chair Emeritus of the National Social Anxiety Center (NSAC), an association of more than thirty regional clinics around the US dedicated to fostering evidence-based services to people struggling with social anxiety. He has directed the Social Anxiety Help clinic (NSAC District of Columbia) in Washington, DC, since 1990 where he has provided cognitive-behavioral therapy (CBT) for more than 1,000 persons with social anxiety, and has conducted 100 20-week social anxiety CBT groups. Cohen is certified as a diplomate in CBT by the Academy of Cognitive and Behavioral Therapies (ACBT), which has also conferred on him the status of fellow for having “made sustained outstanding contributions to the field of cognitive therapy.”

CBT: Meeting the Needs of a Changing World

Mon, 08 Sep 2025 19:26:34 GMT

Written by Dr. Janeé M. Steele, PhD, LPC

I did not always plan to become a CBT therapist. In fact, during my doctoral training, I initially had somewhat of an aversion to CBT. I’d always been a flower child of sorts, and what I perceived to be the cold logic of CBT did not sit well with my intuitive, person-centered beliefs about healing.

Then I began seeing clients. Suddenly, those core conditions of acceptance, empathy, and authenticity felt necessary for therapeutic change, but not sufficient. Instead, every session felt like a freefall, guided by deep caring, but lacking structure. I needed a framework that would be more directive in helping me and my clients know where to go next. That’s when I turned to CBT.

In a time before Amazon, I remember walking into my local Barnes & Noble and asking the sales associate where the books on CBT were. He pointed to a nearby shelf, and I walked over and picked up the last copy of the only book they had on the subject, Mind Over Mood, published in 1995 and authored by Dennis Greenberger and Christine Padesky. I took the book home, completely unaware of how much it would revolutionize the way I thought about how problems develop, and more importantly, how people find their way through them.

I was a late convert, but CBT has long been considered the gold standard of care within the psychological community. This is because decades of research have consistently shown CBT to be highly effective across a wide range of mental health concerns. Yet, the theory is not without its criticisms. In particular, scholars have noted two primary limitations.

Discovering CBT

Limitations of Traditional CBT

The first limitation of CBT is the Eurocentric worldview from which it was derived. Recently, I had an opportunity to speak with Judith Beck about this. She shared that many early CBT researchers, like many researchers in the social and medical sciences, relied on subjects who were often White, male, and middle class, though subjects in her father’s (Aaron Beck’s) studies were more diverse in terms of race, gender, and socio-economic status. Many treatments developed at the time, including CBT, did not fully account for the experiences, values, and cultural contexts of clients who weren’t from the dominant culture. For example, CBT’s initial emphasis on individual thoughts and behaviors reflected a distinctly Western and individualistic worldview, one that prioritized personal responsibility and autonomy over collective and relational ways of understanding problems and healing.

Beyond the research base and worldview from which it is derived, scholars have also noted that oppressive systems and other societal influences which contribute to the client’s problems were not typically considered a standard part of conceptualization. For example, experiences with prejudice and discrimination can play a central role in the origin and maintenance of distress, yet these factors have not always been fully acknowledged within traditional CBT models. Without acknowledging these realities, CBT can minimize the inequities and barriers people with marginalized identities face, invalidate their experiences, and unintentionally place the burden of change on the client.

Acknowledging Systemic Inequities

At a moment when systemic inequities are difficult to ignore, the weight of these criticisms feels especially heavy. Around us, people are losing their rights, indignities are becoming normalized, and the baseline of human decency is slipping. These realities don’t just shape the social landscape, they leave deep psychological imprints, fueling anxiety, depression, and a pervasive sense of disconnection.

Amid this widespread social strain, the limits of traditional CBT can no longer be overlooked. The world is changing. In order for CBT to meet the needs of a changing world, it too must change. Two shifts in light of the criticisms discussed above feel especially urgent. First, CBT must do a better job of integrating cultural context and collective values into therapy, recognizing that problems are not formed or healed in isolation but within families, communities, and broader systems. Second, CBT must expand its vision beyond symptom reduction to embrace liberation and empowerment, helping clients not only manage distress but reclaim agency and affirm identity. Fortunately, CBT has already taken steps in this direction. For instance, in a recent conversation with Christine Padesky, she told me that she and Dennis paid special attention in writing the 2nd edition of Mind Over Mood (2015) to include more cultural diversity. Even so, she acknowledged that efforts to make CBT culturally adaptive are still in their early stages. In clinical settings, therapists can build upon this progress and the work of scholars leading these efforts such as Monnica Williams, Broderick Sawyer, and even myself to not only help clients manage symptoms, but also honor their stories, communities, and rights to joy and liberty.

Integrating Cultural Context and Collective Values

Application of an Integrative Approach

In one example, I worked with an African man struggling with anxiety and depression. He was having some success with the cognitive restructuring and behavioral activation strategies we implemented, but his improvements seemed to only go so far. Curious about what might be missing, I researched cultural views on the origin of psychological problems within his ethnic background and learned that problems were often understood in relation to unresolved traumas in one’s ancestral line. When I asked the client if this perspective resonated, he said yes, and that acknowledgment opened up an entirely new route in our work together. Together, we used guided discovery to explore this spiritual perspective, which uncovered negative core beliefs about being a failure and unhappy regardless of his choices. With this culturally nuanced understanding, we were able to integrate ancestral wisdom, incorporate body-centered practices rooted in African healing and movement, and draw on spirituality to deepen self-compassion and loving-kindness as strategies to counter his sense of failure.

Before moving on, I want to make one critical point. These ideas are not just for people with marginalized identities. Cultural context shapes us all, whether we hold marginalized or privileged identities. Therefore, it’s important that all clients are given opportunities to explore how cultural values, norms, and systemic forces influence their beliefs, behaviors, and sense of self. In another example, I worked with a White man struggling with depression that he linked in part to career dissatisfaction. Over time, it became clear that much of his distress stemmed from cultural values he had internalized at the expense of his own happiness, including individual achievement at the cost of relationships, competition, control over the environment, and the belief that success and attractiveness are determined by status and power. These values left him feeling disconnected and unfulfilled. By naming the dominant cultural norms at play and the oppressive narratives they help to support, we were able to challenge rigid beliefs about success and broaden his sense of what a meaningful and balanced life could look like.

Embracing Liberation and Empowerment

Within the examples shared above is the notion that symptom reduction alone is not enough. Clients’ responses to oppression are often understandable, even reasonable, given the conditions they face. If therapy only seeks to adjust clients so that they can better tolerate unjust circumstances, it risks causing further harm by invalidating their lived realities. More concerning, it can also reinforce the very oppression that contributes to their suffering, leaving systems of inequity unchallenged.

Returning to my example of the African client experiencing depression, part of his presenting concern was the racism he faced at his place of employment. These experiences of discrimination not only caused him to worry that he would lose his job but also triggered his core belief that he was a failure, as he relied on his earnings to provide for his family back in Africa. In therapy, increasing his critical consciousness about the systemic nature of racism became just as important as challenging his negative thoughts. In fact, learning more about racism in the workplace helped to dispel some of the self-blame he experienced in the situation, which was cathartic in itself. Strengthening his self-advocacy skills so that he could navigate workplace challenges with greater confidence and agency also helped to provide relief.

Discovering Joy

Conclusion

The vision of CBT I describe in this blog, a vision that honors cultural context and empowers resistance to oppression, points to how CBT must continue to evolve in order to remain relevant and responsive in a changing world. When I first encountered CBT, I resisted it, dismissing it as too cold and mechanical for the kind of healing I believed in. Yet over time, I came to see its strength as a framework flexible enough to provide structure while also holding space for empathy, identity, and empowerment. The future of CBT depends on this balance, offering clients tools to reduce distress while also affirming their humanity, honoring their experiences, and supporting their steps toward liberation.

About the author:

Dr. Janeé Steele is the Owner of Kalamazoo Cognitive and Behavioral Therapy, PLLC, where she provides therapy, clinical supervision, and training in cognitive-behavioral therapy. In addition to her clinical work, she is an educator, author, and speaker specializing in diversity, equity, and inclusion (DEI). Dr. Steele emphasizes that DEI affects everyone. Without practices that promote belonging and equity, organizations experience declines in morale, creativity, productivity, and overall wellness, while individuals impacted by inequities may face psychological harm. To address these challenges, she developed the DARE approach to DEI, which focuses on implicit bias: Define implicit bias, Assess personal bias, Reduce bias, and Engage in regular reflection on values, stereotypes, and worldviews.

Through her work, Dr. Steele helps organizations and clinical practices foster cultures of belonging by reducing bias, increasing cultural sensitivity, and creating equitable opportunities for all. She also serves as a board member of the Academy of Cognitive and Behavioral Therapies.

Advances in CBT Newsletter - Spring 2024

Thu, 06 Jun 2024 18:19:25 GMT

Archived Academy Newsletters can be found here.

Stay up to date on the latest Academy of CBT News.

Colleagues,

I am happy to share with you the latest issue of our joint newsletter !

The Advances in Cognitive Behavioral Therapy newsletter is a joint publication of the Academy of Cognitive & Behavioral Therapies and the International Association of Cognitive Behavioral Therapy. We have a great issue that is focused on major updates from the organizations including new leadership, free student memberships, and the upcoming international congress. We also have a number of excellent book reviews and a clinical strategy from the trainers corner. If you have any feedback or ideas for future issues, feel free to reach out to me directly walt2155@pacificu.edu .

Best Wishes,

Scott Waltman

Editor, Advances in Cognitive Behavioral Therapy Newsletter

Advances in CBT Newsletter - Winter 2023

Fri, 15 Dec 2023 17:05:12 GMT

Archived Academy Newsletters can be found here.

Stay up to date on the latest Academy of CBT News.

Colleagues,

I'm excited to be able to share with you the latest issue of our newsletter - Advances in Cognitive Behavioral Therapy. This issue includes cutting edge updates from across the field and instructions for register with our new website.

Submissions to Advances in Cognitive Behavioral Therapy are reviewed on an ongoing basis. Topic areas may include clinical issues, cultural considerations, research updates, conference and training information, book reviews, and summaries of any CBT-related activities from around the world! Please reach out to me if you have ideas for the newsletter.

best wishes

Scott Waltman

Editor, Advances in Cognitive Behavioral Therapy Newsletter

MEET A-CBT TRAINER: LESLIE SOKOL

Mon, 02 Oct 2023 14:52:27 GMT

Leslie Sokol, PhD , a licensed psychologist, is an internationally recognized leader in the field of cognitive behavioral therapy with almost 40 years of experience in practice, teaching, and research.

She was a past Director of Education and one of the principal instructors at the internationally acclaimed Beck Institute for Cognitive Behavior Therapy. She is one of the leading CBT speakers in the world providing teaching and training to professional and paraprofessional groups, both nationally and internationally, on a multitude of CBT topics.

A Valued Member of the CBT Community,

Dr. Sokol is a distinguished founding fellow of the Academy of Cognitive and Behavioral Therapies, past president, and current Chairman of it's Credentialing Committee. She is a fellow of the Association for Behavioral and Cognitive Therapies (ABCT) and the President-Elect of the International Association of Cognitive Psychotherapy (IACBT). Dr. Sokol also served as a Chairman of Behavioral Science for the Mercy Suburban Hospital Family Practice Training Program for over 20 years.

Dr. Sokol has co-authored numerous books and book chapters. Her most current books are: 'The Ultimate CBT Workbook', 'The Comprehensive Clinician's Guide to Cognitive Behavioral Therapy', 'Teaching and Supervising Cognitive Behavioral Therapy', 'Think Confident, Be Confident for Teens: A Cognitive Therapy Guide to Overcoming Self-Doubt and Creating Unshakable Self-Esteem', 'Think Confident, Be Confident: A Four-Step Program to Eliminate Doubt and Achieve Lifelong Self-Esteem', and 'The Think Confident, Be Confident Workbook for Teens: Activities to Help You Create Unshakable Self-Confidence and Reach Your Goals'. She maintains a private practice in the Philadelphia suburbs.

ACADEMY NEWSLETTERS

sales@associationsphere.com (Blue Hill) — Sun, 01 Oct 2023 07:09:39 GMT

Archived Academy Newsletters can be found here.

Stay up to date on the latest Academy of CBT News →

At A-CBT, we share quarterly newsletters to keep you informed with the latest updates in CBT—covering new research, insights, and scholarly publications. As an Academy member, you’ll receive these newsletters via our ListServe communication platform. Non-members can view archived editions after their release. Click a newsletter below to explore the most recent CBT & Academy news.

March 2007 Newsletter

April 2008 Newsletter

June 2014 Newsletter

October 2014 Newsletter

February 2015 Newsletter

June 2015 Newsletter

October 2015 Newsletter

February 2016 Newsletter

October 2016 Newsletter

February 2017 Newsletter

June 2017 Newsletter

October 2017 Newsletter

February 2018 Newsletter

June 2018 Newsletter

October 2018 Newsletter

February 2019 Newsletter

June 2019 Newsletter

December 2019 Newsletter

October 2020 Newsletter

February 2021 Newsletter

Winter 2021 Newsletter

Summer 2021 Newsletter

Summer 2022 Newsletter

Fall 2022 Newsletter

Winter 2023 Newsletter

Spring 2023 Newsletter

LATEST RESEARCH & INFO ON CBT

sales@associationsphere.com (Blue Hill) — Sat, 30 Sep 2023 07:09:39 GMT

Google News Feed

Write about what you know

The Academy is proud to present the latest news and research on CBT, brought to you by Google news. Access the new feed here .

Coming Soon - AI for CBT Research

The Academy is actively working on expanding our ability to provide our members with up-to-date CBT research and cutting edge technology. Look out for these updates beginning 2024.

HELP US HELP OTHERS

Supporting the Academy helps support CBT Therapists worldwide.

A portion of your donation goes directly to supporting our BIPOC CBT therapists and trainers.

A-CBT Diplomate Application Tips (CBT Certification)

Mon, 02 Jan 2023 06:51:34 GMT

Ready to begin your CBT Certification today? Here are some tips to get started.

Starting your path to CBT Certification is easy.

At A-CBT, we offer certification programs in Cognitive and Behavioral Therapies for mental health professionals. Applicants should hold a terminal degree in their field and have a license for independent practice. If licensing isn't applicable, alternative credentials can be reviewed. A minimum of 40 hours of cognitive therapy education is required, with training available in various formats. Applicants need at least one year of clinical experience using cognitive therapy with a minimum of ten patients. Eligible terminal degrees include M.S.W, M.D., Psy.D., and others. Malpractice insurance may be necessary. CBT certification demonstrates competence and expertise, requiring specialized training and an examination. The application process involves submitting documentation and fees, as well as a case conceptualization and session audio evaluation. The certification process takes approximately 8-12 weeks.

Application Tips:

Ensure you have a terminal degree in a mental health discipline and the required license for independent practice.
If you don't meet licensing requirements, prepare alternative credentials for review.
Complete at least 40 hours of cognitive therapy education in any format.
Gain one year of clinical experience using cognitive therapy with a minimum of ten patients.
Verify that your terminal degree is eligible for the CBT certification program.
Consider obtaining malpractice insurance if necessary.
Thoroughly review the application requirements and submit all necessary documentation and fees.
Prepare a case conceptualization and session audio for evaluation.
Expect the certification process to take around 8-12 weeks.
Keep in mind that CBT certification can enhance your career, demonstrate your expertise, and provide credibility in the field of cognitive and behavioral therapy.

Have additional questions? Email us at info@academyofcbt.org for more information.

We look forward to receiving your application soon.

academyofcbt

Dating with Social Anxiety in the Digital Landscape

Expanding Access to CBT Training: A-CBT and Renewal & Reward Center Launch Additional Cohorts

A Training Model Designed for Real Clinical Competence

Bring This Model to Your Team

Assessing AI Use in CBT: A Modern-Day Ritual

The Modern Ritual: AI as a Safety Behavior

Functional Analysis: How AI Maintains Anxiety

Why CBT Therapists Should Take Notice

Integrating AI Use into CBT

Moving Forward: CBT in a Digital Age

Religiosity/Scrupulosity OCD in Judeo-Christian Contexts

Highlighting Mental Imagery in CBT

CBT in the Arab World: Cultivating Learning, Practice, and Transformation

Dr. Lata McGinn Receives the Lifetime Achievement Award in CBT

Advances in CBT Newsletter - Fall 2025

Fall 2025

Shame: The Oft-Neglected Target in CBT for Social Anxiety

Shame: The Oft-Neglected Target in CBT for Social Anxiety

Core Beliefs Generating Shame and Anxiety

SAD Facts

The Vicious Cycle of Social Anxiety and Shame

Mingling with Strangers

Speaking to a Group

Breaking the Vicious Cycle

Integrative CBT

CBT: Meeting the Needs of a Changing World

Written by Dr. Janeé M. Steele, PhD, LPC

Discovering CBT

Limitations of Traditional CBT

Acknowledging Systemic Inequities

Integrating Cultural Context and Collective Values

Application of an Integrative Approach

﻿

Embracing Liberation and Empowerment

Discovering Joy

Conclusion

About the author:

Advances in CBT Newsletter - Spring 2024

Archived Academy Newsletters can be found here.

Advances in CBT Newsletter - Winter 2023

Archived Academy Newsletters can be found here.

MEET A-CBT TRAINER: LESLIE SOKOL

ACADEMY NEWSLETTERS

Archived Academy Newsletters can be found here.

LATEST RESEARCH & INFO ON CBT

Google News Feed

HELP US HELP OTHERS

A-CBT Diplomate Application Tips (CBT Certification)

Ready to begin your CBT Certification today? Here are some tips to get started.