Overcoming Social Phobia

1. What Is Social Phobia?
   • Everyone feels social anxiety sometimes. Social phobia is when your life is disrupted by social anxiety.
   • Those suffering from social phobia assume that others are assessing them negatively. They are apprehensive that they will do something shameful or disgraceful in public.
   • The symptoms of social phobia have effects on:
     • thinking e.g. worrying about the opinion of others;
     • behavior e.g. avoiding eye contact;
     • the body e.g. visible signs of anxiety such as blushing;
     • emotions e.g. feeling inferior.
   • Social phobia leads to people avoiding problematic circumstances, distancing themselves from risk, being anxious about situations both before and after they occur. They may experience anger, depression, inferiority as well as anxiety.
   • Social phobia can be an obstruction to a person’s professional and private life. It may be limited to one aspect of your life or it may have more general effects.
   • You do not need to know the precise cause of social phobia in order to alter it

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2. The Important Function Of Thinking In Social Phobia
   • Thinking has a most important function in social phobia. Your thoughts affect your feelings – the foundation of cognitive behaviour therapy.
   • There are many sorts of thinking/cognition and thoughts are often hard to verbalize.
   • There are three levels of cognition:
     1. things you observe and focus your attention on;
     2. negative automatic thoughts;
     3. underlying beliefs and assumptions.
   • Imagery can trigger powerful feelings and can play a central role in social phobia.
   • As social phobia alters, the meaning of social problems also alters to become less distressful.

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3. What Causes Social Phobia?
   • Social phobia is not caused by other people although the things they do can set off the symptoms.
   • Some contributory factors are:
     • biological factors – a more reactive arousal system and personality;
     • environmental factors – relationships with parents and childhood carers, experience of being criticized, praised etc, need for social learning opportunities, learning from the experience of problems;
     • bad and traumatic experiences;
     • problems dealing with what is required of different life stages;
     • stresses that affect relationships with others.

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4. Understanding Social Phobia
   • A model for social phobia is that a trigger situation activates beliefs and assumptions then the situation is seen as socially dangerous. This leads to cycles of safety behaviours and signs and symptoms of anxiety with self-consciousness and attention focused on self at the centre of the model.
   • The different cyclical processes maintain social phobia.
   • Self-consciousness means that people with social phobia tend to form a biased view of their selves.
   • Saftey behaviours hinder a person from learning that social situations are not to be feared.
   • Patterns of thinking reflected in a person’s beliefs and assumptions decide the manner in which social events are seen and explained.
   • Breaking these cycles can lead to an increase in self-confidence.

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5. Initial Steps
   • Procure a notebook or folder and find a place to keep your social phobia work.
   • Make a note of your symptoms of social phobia. Write down at least one from each affected area: your thinking; your behaviour; your body; your emotions.
   • Define your aims: How does social phobia affect you? What are the symptoms that trouble you? How do you want things to be different?
   • Consider how you will find time for your social phobia work.
   • Set your self regular tasks and proceed at your own pace.
   • Keep in mind that beneficial strategies are with no long-term disadvantages.
   • To get a new perspective on the problem involve yourself in more things you enjoy that are stress free.
   • It is healthy to spend time on one’s own so make a list of solitary activities and if you feel you have too much time alone try to make some of these activities interesting and enjoyable.
   • Learn to identify the vicious cycles that maintain the problem so that you can break them. You will need to persevere and not let the problem control your life. Start with easy things first and build up to difficult ones.
   • If you want to you should work at becoming socially skilled. You will acquire social skills as you progress but you do not need to be socially skilled to be successful. When you are more at ease you may find that social skills come naturally. Being adaptable will enable you to do things from natural impulse rather than learning set rules.
   • You can learn about social conventions by asking, using the information given, watching, listening and looking out for how other people do things in particular situations.
   • A severe bout of anxiety will not do physical harm.
   • The signs of anxiety and panic alone, however strong do not mean that a serious mental illness is developing.
   • Anxiety will leave you feeling tired and if you are also depressed you should see your doctor about it.
   • You should avoid taking a break to rest if it is a way of not facing your problem.
   • If you do not learn how to overcome the problem it might disappear by itself but it will take longer than if you do take action against it.
   • It may be that you were born with a higher sensitivity to stress but you can still learn to overcome social phobia.
   • You cannot totally cure yourself of anxiety since it is normal to feel anxious sometimes but you can alter your thoughts and behaviour so that you cope better with social situations.

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6. Altering Patterns of Thinking
   • Thinking affects your feelings and how you feel affects your thinking. By altering your thoughts you will feel better.
   • You need to recognize the different types of thoughts which include ideas, expectations and attitudes.
   • Try to become aware of the thoughts that enter your mind when you are anxious. Consider a recent situation in which you suffered from social phobia. What were your thoughts when the anxiety began? What thoughts followed these? What were your thoughts after the situation was concluded? What might have been the worst-case scenario at the time? What is it about the event that is important to you? Think about both what this incident means to you and about you. Identify any thoughts that made you feel worse and the thoughts that are important for you.
   • To help you identify your thoughts when anxious, record: the specific situation, your emotions, note separately each of your different thoughts.
   • You need to recognize bias in your thinking so that you can rectify your thoughts. Patterns of biased thinking include:
     • being personally affected by things;
     • taking the blame when you are not at fault;
     • mind reading – thinking you know someone’s thoughts when you do not;
     • discounting the positive;
     • jumping to negative conclusions – interpreting things without evidence;
     • emotional reasoning – an over-reliance on feeling to guide judgments;
     • catastrophizing – predicting the very worst;
     • over-generalizing – you notice something true and make generalizations about it;
     • predicting the future;
     • labeling – calling yourself names;
     • wishful thinking.
   • Next you need to look for alternative ways of thinking. Write down the answers to the following questions about your upsetting thoughts: Consider both supporting and contradictory evidence for the way you think. What do the facts suggest is the best way of thinking? What are the alternatives? Consider how being more confident would affect your thinking and how someone else might see things. What would you say to someone else who had the same thoughts? What advise might a friend give you? What is the worst-case scenario? What is the best-case scenario? Which is most realistic? Is your thinking biased? What helpful things can you do? What are your skills and strengths and experience of coping with similar difficulties? What support is available to you?
   • Record separately each of your upsetting thoughts and possible alternatives e.g. ‘Perhaps I cannot tell people’s real thoughts’. A good alternative is moderate and balanced.
   • When you have pressurizing and extremist thoughts e.g. ‘I must’ and ‘always’, look for more moderate and balanced ways of thinking.
   • Doubting yourself - the ‘yes but’ syndrome makes searching for alternatives difficult.
   • By adopting the approach you would use when aiding someone else you will find it easier to come up with alternatives
   • Now record your change in feeling for each of the situations for which you have identified upsetting thoughts and possible alternatives, giving a score between -10 to +10 with +10 being feeling much better and 0 as no change at all.
   • Write down an action plan of what you would like to do differently. You will achieve more if you practice your new ways of thinking so that you alter your behaviour as well as your thinking.
   • Make flashcards to help you remember new patterns of thinking.

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7. Changing Your Behaviour
   • Altering your behaviour is the most effective way of improving your confidence.
   • Consider what you would be able to do if you were not so anxious and what it would mean if you could, so that as you change your behaviour you keep in mind the implications.
   • You need to carry out small experiments to discover what occurs when you alter your behaviour.
   • Experiments that help you give up safety behaviours and face things rather than avoid them, break cycles maintaining social phobia.
   • A small experiment has four steps:
     1. You need to become aware of your safety behaviours – what you do to protect yourself.
     2. Think about exactly what could go wrong – what would you predict would occur if you abandoned your safety behaviours?
     3. Find out what happens if you alter your behaviour – create an experiment for yourself in which you find out what occurs if you enter a situation without the protection of your safety behaviours.
     4. Evaluate what happens – what occurred when you altered your behaviour and what does this mean to you? Were your predictions correct? Try to remember that the worst is more likely to happen if you keep using safety behaviours than if you abandon them.
   • Record each specific situation in which you use safety behaviours. Write down your prediction – what will happen if you abandon the safety behaviour? Note your experiment – how you will alter your behaviour? Write down what actually happened and your conclusions.
   • In experiments to face things rather than avoid them: recognize what you avoid; what do you predict would happen if you no longer avoided these things?; find out what happens if you alter your behaviour – face your fear rather than avoid it; evaluate what happens – what occurred when you altered your behaviour and what does this mean to you? Were your predictions correct?
   • Record each specific situation in which you face your fears rather than avoid them. Write down your prediction – what will happen if you face your fear? Note your experiment – how will you alter your behaviour? Write down what actually happened and your conclusions.
   • It may take some time for progress to become noticeable. Acknowledge your achievements and do not be discouraged by setbacks as these are a normal part of progress.
   • Changing behaviour involves taking risks but in time you will find you no longer react to these situations as if they were really frightening.

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8. Self-Consciousness
   • Self-consciousness arises when you concentrate your attention on your inner experience and what is happening to you.
   • It is at the heart of all vicious cycles that maintain social phobia.
   • It also exacerbates the problem.
   • Concentrating your attention inwards makes you notice the things inside yourself but deprives you of accurate information about what is going on.
   • To clarify how self-consciousness increases your vulnerability, consider for specific situations the evaluations you made of yourself after you felt self-conscious and what evaluations you think others would have made at the same time.
   • In order to reduce self-consciousness you need to be aware of how it affects you and learn to focus your attention outside yourself.
   • First decide not to think about unpleasant experiences. Always keep in mind that the danger is more in your imagination than real. Use the thinking skills you learned in 6) Altering Patterns of Thinking to find a new perspective for your thoughts about social danger and catastrophe. Ask yourself if there is anything to gain from dwelling on unpleasant experiences and write down the advantages of not thinking about these unpleasant experiences.
   • Next fill your mind with something else – focus on what is happening around you.
   • If your mind wanders repeat your original plan and turn your attention outward again. Think about things outside yourself and do things to help occupy your attention.
   • Carry out a two-way experiment: focus your attention inward for a while then note how you felt and what you noticed; focus your attention outward for a while then note how you felt and what you noticed.
   • Compare the two: how did they differ and in what way were they the same?
   • Summarize your evaluations: Which way made you feel better? Which way provided you with more helpful social information? Was focusing externally hard to do? How did you do it? Could you do it again, in more demanding circumstances?
   • It will take courage to stop withdrawing into you and instead to concentrate on what is happening externally.
   • As you work on your self-consciousness and start to focus on what is happening externally, your perceptions will change; altering your thoughts will change your interpretation of what occurs and doing things differently will give you new memories.

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9. Consolidating Your Confidence
   • Confidence is not inherited and whatever your experience, your self-confidence can increase.
   • Confidence varies from moment to moment and even confident people can have doubts sometimes.
   • Build your confidence by behaving ‘as if’ you were confident. When you behave confidently you will feel better and your different behaviour will draw out different behaviour from others.
   • Seek out success as this will consolidate your confidence. Try participating in altruistic activities which can enable you to forget yourself and your anxiety and boost your confidence.
   • Confidence comes from doing difficult things.
   • You may have underlying beliefs and assumptions which hinder your progress. They have formed from life experience and can be altered. They supply the window through which you see the world.
   • There are three levels of thinking: underlying beliefs and assumptions; automatic thoughts; attention.
   • What you believe and assume affects your thoughts and what you notice. By learning to alter your beliefs and assumptions you will bring about the other changes you desire.
   • Identify your underlying beliefs. Think of a particular situation in which you recently felt socially anxious. How do you think you were at fault? How are you judging yourself? What did the extent of the difficulty mean to you? What is the importance of this about you? What are the ways other people are thinking and behaving? What does this reveal about them?
   • Write down a sentence about how you are and another about how others are.
   • Next you need to change your beliefs by learning how to re-examine and make them less severe. It is necessary to separate facts from opinions.
   • How would you judge and advise someone else who had your belief? Are you treating yourself justly? Are you aiming for perfectionist standards? Are you concentrating on your weaknesses and failures while disregarding your strengths and successes? Is your thinking biased? Are your conclusions based on your early experiences? Are you judging yourself as others have in the past? If so, who knows best, you or other people?
   • Using the questions and format in Altering Patterns of Thinking, write down your belief, possible alternatives, and change in feeling and action plan.
   • You need to search for new information since you tend to not notice information that does not fit with your beliefs.
   • Start by writing down your belief and rating the strength 0-100%
   • Think of a future event relevant to your belief that you are anxious about. Before this event, consider how it will be problematic for you and what you predict will happen based on this belief. Define what you should look out for so that your belief no longer filters your view of the event. After the event, note what actually occurred and what you can conclude from this. Have you noticed things you would not have otherwise noticed? Has it shown how your belief hinders your thinking? Has it shown any of your predictions to be wrong? Rate your belief again 0-100% in strength. Does your belief need to be made less severe? If so, how?
   • Your belief rating will change as you find more new information.
   • Building more positive beliefs gives your confidence a firm foundation.
   • To change your assumptions you need to behave differently. Identify your assumption, usually expressed as ‘should’, ‘must’, ‘ought’, ‘have to’ and word it as an ‘if…then…’ statement. Identify the behaviour that fits with the assumption then behave differently to break the old rule. Evaluate what occurs and re-think your assumption.
   • Make a flashcard with your belief or assumption on one side and a summary of new ways of thinking on the other.

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10. Dealing With Interpersonal Relationships
    • Interpersonal relationships may have caused your social phobia or may be preventing you from recovering – in any event interpersonal relationships will be affected by your social phobia.
    • You need to understand your personal relationships and be able to deal with them effectively.
    • Draw interpersonal maps for:
      1. How your interpersonal relationships are at present;
      2. How your interpersonal relationships might be now if you did not suffer from social phobia;
      3. How your interpersonal relationships will be in 10 years if you continue to suffer from social phobia;
      4. How you would ideally like your interpersonal relationships to be.
    • These will summarize all your relationships and allow you to recognize any changes you may desire.
    • List all your important relationships and put yourself in the middle of the map in a circle.
    • Place each person’s name in a circle on the map, around you in the middle – the closer the relationship to you, the closer the circle to you.
    • Join these circle’s to you in the middle with an arrow outward if it is you mainly giving; an arrow inward if you are mainly receiving; a two-way arrow if giving and receiving is balanced; a question mark if you are unsure.
    • Examine these maps noting any differences and set yourself goals to make any desired changes to your relationships.
    • For each relationship ask yourself:
      • who initiates and terminates contact;
      • are you happy with how often you see this person? ;
      • who decides what to do or what to talk about? ;
      • is there a balance between giving and receiving? ;
      • do you want to alter the relationship in any way?
    • Consider questions such as:
      • who could I confide in and get advice from? ;
      • who would be there for me if I fell ill? ;
      • who would lend me money at very short notice?
    • Next time you have contact with each person, examine the relationship – participate and observe. Were your predictions correct? – If not, what was different?
    • When you have a complete picture of your relationships, think about how you maintain them and in what way you want to change your relationships.
    • Two important reasons for making changes are:
      1. A balanced and supportive social network is necessary for your well-being;
      2. By altering your relationships but avoiding being controlling, you may increase your sense of control.
    • Start by making small changes and monitoring progress. You could also try discussing what you have learned about the relationship with the individual.

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11. Removing The Obstacles To Intimacy
    • Record and examine closely the things that prevent you from achieving intimacy with someone. Note your thoughts and reactions when you distance yourself from a friend or end a relationship and make an analysis e.g. are you overgeneralising?
    • Social inadequacy can be an obstacle to intimacy. Apply your assertiveness skills to your social and work life and observe how socially skilled people handle situations in particular difficult ones. Rehearse your social behaviours so that you are comfortable with them.
    • Try to grasp your anxious thoughts, examine them closely and if required, challenge them. What are your anxious thoughts? Is your outlook biased – are there misjudgments? Consider the evidence to support and discount your thoughts.
    • It is possible to become over-intimate and make ourselves vulnerable to exploitation. Trust can be given in a series of stages and you can fluctuate as to how much you trust someone.
    • Communication is necessary for all relationships. Record the feelings which threaten your relationship (e.g. jealousy) and grasp the automatic thoughts. Analyze them and find alternative ways of dealing with the situation.

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12. Assertiveness Training
    • The aim of assertive behaviour is to stand up for your legitimate rights and face others without putting yourself or them down.
    • Assertiveness training teaches you to increase the number and variety of situations in which you are assertive.
    • There are three types of interpersonal behaviour:
      1. Aggressive - you may be forceful in expressing your opinions, feelings and wants.
      2. Passive - your opinions, feelings and wants may be withheld completely or partly.
      3. Opinions, feelings and wants are stated with respect for the rights of others.
    • Make sure you are aware of your fundamental rights which include: asking for what you want; saying 'No' without guilt; not being perfect; being ignorant about something; being responsible for your actions; having your own perspective and emotions; being indecisive; choosing whether or not to deal with others' difficulties; expecting privacy, independence and success.
    • There are five steps to being assertive:
      1. What do you want? ;
      2. What is fair? ;
      3. Be clear in asking for it;
      4. Contemplate and be ready for the risks;
      5. Stay calm
    • Practice your arguments in advance and repeat yourself to get the message across. Be prepared to negotiate.
    • Think about situations in which you are not assertive and how you could change this and be assertive.
    • Write out a detailed description of problem scenes - note when and where the problem occurs; who is involved; what your difficulties are; how you handle it; your fear of what will happen if you are assertive; your goal.
    • To deal with a problem situation:
      1. Consider your rights and wants.
      2. Unless spontaneous action is required, arrange a mutually convenient time to discuss your problem with the other person.
      3. Define the problem as specifically as possible.
      4. Describe your feelings using 'I' messages, to give the other person an understanding of how important the issue is to you.
      5. Make your request in one or two simple but firm sentences.
      6. Give positive reinforcement to get what you want e.g. we'll be able to spend more time together. If this will be ineffective try negative reinforcement, describing the alternative way you will look after yourself if your wishes are not met.
    • You need to arrive at a workable compromise. Agree to review this after a specified length of time and if you are not both satisfied you can renegotiate.
    • Avoid being manipulated - techniques include:
      1. 'Broken Record' where you choose a concise assertive statement to say over and over to get your message across.
      2. Delay responding to a challenging statement until you are more prepared.
      3. Inviting criticism may reveal what is troubling the other person.
      4. When someone puts you down, acknowledge something you can agree with in their criticism and ignore the rest.
      5. You can change the focus, from discussing the topic to analyzing the interaction between the two of you.
    • In instances where you lack time you could use the short form assertiveness technique. Consider:
      1. Your thoughts - state the facts as: 'I think…'
      2. Your feelings - express as 'I' statements: 'I feel…'
      3. Your wants - specify behaviour change as: 'I want…'
    • You need to develop assertive body language. Practice the following basic rules in front of a mirror so that you learn how to apply them to problem situations:
      1. Maintain eye contact and an erect body posture.
      2. Speak clearly and firmly.
      3. Emphasize what you are saying with gestures and facial expressions.
    • Learn to listen assertively:
      1. Make sure you are both ready to listen.
      2. Listen giving the other person your full attention and ask them to clarify if necessary.
      3. Let the other person know you have heard what s/he has expressed to you.
    • Practice being more assertive in problem situations and consider how it makes you feel.
    • Role-playing is a good way to improve your assertiveness in a safe environment before trying it out in real life situations.

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13. Problem-Solving
    • Problems of any sort can cause distress to a person with social phobia.
    • The problem-solving approach can be useful in these cases. You learn to focus your thinking and find solutions to your problem instead of becoming frustrated. There are six steps in problem-solving:
      1. Define the Problem – Be specific and try to break the problem into more manageable tasks. Do one task at a time. Choose your task and specify your goal.
      2. List Solutions – Try to write down as many ideas, to solve your problem, as you can.
      3. Evaluate the Pros and Cons of Each Solution – Consider your solutions and reject the unsuitable ones. List the remaining solutions in order of usefulness.
      4. Selecting a Solution and Planning Action - Choose your first solution and decide how you will put it into action. Rehearse your task and make sure you have a back-up plan in case your task does not go as planned.
      5. Do it - Attempt your solution.
      6. Review the Result of the Solution – If your solution is successful try to understand why it was so. If your solution is unsuccessful try to comprehend why it did not work. Praise yourself for having tried and choose your next solution from your list.

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14. Stress Awareness Training
    • You need to monitor your stress and become familiar with what sets it off and the feelings, thinking and actions associated with the anxiety. You can do this by keeping a diary. When you feel anxious note the date and time. What was the event? Rate your distress 1-10 (1 is no distress and 10 is extreme panic). What caused your anxiety? What was your response to cope with the problem? Re-rate your distress.
    • After two weeks of monitoring your stress levels you should become aware of what triggers your distress, your bodily feelings and thoughts when distressed, how your distress levels vary with different situations, what you tend to do when distressed and what is the best way for you to cope with your distress.
    • Make two lists – one of short-term only coping strategies and the other of long-term coping strategies. You can refer to these when you feel stressed. Try to incorporate more of the long-term strategies into your set of coping techniques and attempt to gradually abandon your short-term methods.
    • Avoid turning to stimulants such as alcohol, caffeine and nicotine as coping methods. These have unpleasant effects in the long-term.
    • Study your diary to determine what drives your cycles of distress. Is it bodily, psychological, behavioural or social?

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15. Dealing With Bodily Experiences: Controlling Your Breathing
    • Hyperventilation – faster breathing occurs in response to exertion and stress. In the long-term this can be uncomfortable and cause unpleasant physical symptoms which trigger more anxiety and more hyperventilation. Another cycle of stress is set up and can result in a panic attack.
    • You can rectify hyperventilation by learning to control your breathing.
    • First practice lying down and later sitting or standing. Place one hand on your stomach and the other on your chest. Breathe in slowly through your nose until your lungs are full then exhale slowly through your nose. Breathing in and out counts as one breath – aim to take 8-12 breaths a minute.
    • In order to be effective you need to practice this exercise repeatedly.

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16. Dealing With Bodily Experiences: Relaxation
• You need to develop relaxation into a skill you can use when you feel muscular tension due to stress.
• Try to develop a routine and practice your relaxation exercises. Start by lying down and later you can try sitting or standing. Control your breathing.
• Record your experiences noting the date and time. Rate your distress before the relaxation exercise, 1-10 (1 is tense and 10 is very relaxed). Which exercise did you use? Rate your distress afterwards. Make notes of the sort of day it was, your preoccupations etc.
• Below are three exercises – only move to the next one when you are fully relaxed after a routine.
  1. Progressive Muscular Relaxation (PMR) – Breathe slowly and regularly as you focus on different parts of the body: feet – tense your feet then relax and repeat; legs – straighten your legs then relax and repeat; abdomen – tense your abdomen then relax and repeat; back – arc your back then relax and repeat; shoulders/neck – bring your shoulders up and in and press your head back. Relax and repeat; arms – stretch out your arms and hands. Relax and repeat; face – tense your face and bite hard then relax and repeat; whole body – tense your whole body then relax and repeat.
     After the routine if you still feel tense then repeat it then when you are relaxed think of something calming to relax your mind. Get up slowly and gently.
     You should practice PMR twice a day until you feel relaxed after the exercise.
  2. Shortened PMR – You can miss out the tensing and go straight to relaxing the different muscles. When you have achieved this you can progress to using the routine at other times and places.
  3. Simple Relaxation Routine – Identify a word, object or scene you find calming. Sit comfortably and close your eyes. Be aware of your breathing as you inhale through your nose. As you exhale, think about your calming mental image. Continue this until you feel relaxed. You should practice this exercise frequently.
• When you have learned to relax using the three exercises you can start to use the skills throughout the day. Use something to remind you regularly to relax. Apply your relaxation skills whenever you need to use them in response to physical tension.

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17. Dealing With Psychological Aspects: Distraction
    • A cycle of mounting anxiety is set off by alarming thoughts and images. You can break this cycle by distracting yourself.
    • Physical Exercise – If you keep active you are less likely to be preoccupied by worrying thoughts.
    • Refocusing – Distract yourself by focusing on things around you e.g. listening to others’ conversations or studying how someone is dressed.
    • Mental Exercise – Formulate a phrase, picture or mental exercise that distracts you e.g. redesign your home, imagine your dream home in detail or recite poetry.
    • Develop a set of distraction techniques for different occasions that are suited to your needs e.g. If you get stressed at interviews then physical distraction will not be helpful.
    • Make two columns – in one write down the situation causing anxiety and in the other your chosen distraction method.
    • Practice your distraction techniques when you are not anxious and try to catch your anxiety at an early stage.

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18. Dealing With Problem Behaviour: Managing Your Time
    • Good time management requires being aware of:
      1. Your needs and strengths – list these opposite each other.
      2. Your standard procedure – find out how you use your time at present by keeping a record of how you spend your time. From the record you will be able to work out the best way of working. Try to get a balance of work tasks and include breaks.
      3. Your priorities – identify and rank in order of priority the different areas of your life. Consider the time you allocate to each and what is realistic and necessary. Perhaps others are making demands of you that you need to be more assertive about?
      4. Setting reasonable goals – keep in mind the important areas of your life when pursuing goals. Clearly define your goals so you know when you have achieved them. Some goals will need to be broken down into more manageable steps.
    • Once you know the above you can draw up a new more efficient schedule. Use an organizer and list long-term (within six months), medium-term (within a month) and short-term (within a week) goals. Set aside time each day to organize. Try to do a ‘To do’ list of prioritized tasks every day. Plan flexibly and review every month.
    • Delegating – giving over responsibility with authority, to others for appropriate tasks, is part of good time management.

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19. Sleep Management
    • The length of sleep necessary varies from person to person.
    • Worrying will prevent you from sleeping.
    • You need less sleep as you get older.
    • Sleep is affected by mood, stress, food, alcohol, exercise and medicines.
    • In the long-term, sleeping tablets are not helpful and can be addictive.
    • You can manage your sleep problems by changing your behaviour rather than resorting to medication.
    • Keep a sleep diary for several nights to ascertain if you have a problem. Note the date and anything that might affect your ability to sleep e.g. your activity before retiring. If you have waking episodes, note your activity to restore sleep. Was it helpful? Next day note the number of hours of sleep you managed to get and rate how alert you feel 1-10 (1 is dull and sleepy and 10 is very alert). Rate your performance that day 1-10 (1 is poor performance and 10 is performed well). If you do have a problem the following suggestions might be helpful:
      1. Analyze your sleep diary to see if poor sleep is due to stress and is likely to get better as this eases; are there behaviours which result in poor sleep that you could change?; identify helpful and unhelpful ways of coping and avoid the latter.
      2. Introduce pleasant smells into your sleeping environment to help you relax e.g. potpourri or lavender oil.
      3. Try to relax an hour or two before you go to bed. Keep your daily stress low and seek counselling or the support of friends if you feel the need. Exercise during the day. Avoid caffeine, nicotine and alcohol and try a warm milk drink before bed. Make sure you are not hungry before retiring as this will keep you awake. · Ensure you have a quiet bedroom and a comfortable bed and have emptied your bladder before trying to sleep. Use your bed only for sleeping and set an alarm so you wake regularly each day. Avoid naps during the day.
      4. If you sleepwalk you are advised to discuss this with your doctor as it can be dangerous.
    • To cope with disturbing dreams you could try:
      1. Constructing a positive ending to your disturbing dream and mentally practicing this alternative ending several times before sleeping;
      2. Practicing beforehand what you might say if the dream occurs;
      3. Keep water and a towel by your bedside to wash your face with if you wake up sweating - this will help you re-orientate;
      4. Keep a notepad and pencil within reach so you can record your dreams but beware of reading too much into their interpretation.
    • Relaxed Breathing Method:
      You could try the following method of relaxed breathing to ease tension and promote sleep:
      1. Ensure you have some time to yourself and push your worries to one side;
      2. Sit or lie comfortably and close your eyes with your arms by your side;
      3. Concentrate on breathing naturally;
      4. Place your hands on your stomach and breathe in deeply and hold for a few seconds feeling your stomach rise. Breathe out and feel your stomach contract. Repeat and as you breathe out think of a relaxing image or sound. Continue doing this until you feel thoroughly relaxed;
      5. Count back from 10 then open your eyes and feel how relaxed you are now. Slowly get up and resume normal activities.

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20. Conclusion
    • Start with easy tasks then progress to more difficult things. Be realistic and repeat your successes. Give the strategies time to have effect on your problem.
    • You may find it useful to enlist the help of other people.
    • Assertiveness training and learning relaxation techniques may be options you wish to consider to include to the strategies given to enable you to overcome your social phobia and move forward.

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