A NEW HARBINGER SELF-HELP WORKBOOK TheShyness and Cognitive Therapies 一本新的哈宾格自助工作手册
害羞与认知疗法
Social Anxiety 社交焦虑
Workbook Who orkbook SECOND EDITION 工作手册 第二版
PROVEN, STEP-BY-STEP TECHNIQUES FOR OVERCOMING YOUR FEAR 经过验证的逐步技巧，帮助你克服恐惧
MARTIN M. ANTONY, PH.D. RICHARD P. SWINSON, MD 马丁·M·安东尼，博士 理查德·P·斯温森，医学博士
“Social anxiety and shyness can become so intense that they prevent people from enjoying life. This book is ideal for anyone who wants to learn to be more comfortable around other people. Drs. Antony and Swinson have taken proven treatments for social anxiety and adapted them for a non-professional audience. The step-by-step strategies described in this book have been shown to be effective, are easy to understand, and are sure to help the reader cope better in social situations. Anyone who experiences significant anxiety when performing or when interacting with other people should read this book!” “社交焦虑和害羞可能变得如此强烈，以至于阻碍人们享受生活。本书非常适合任何想要在他人面前感到更自在的人。安东尼博士和斯温森博士将经过验证的社交焦虑治疗方法改编为适合非专业读者的版本。本书中描述的逐步策略已被证明有效，易于理解，必将帮助读者更好地应对社交场合。任何在表演或与他人互动时感到显著焦虑的人都应该阅读这本书！”
-Aaron T. Beck, MD, university professor of psychiatry at the University of Pennsylvania ——亚伦·T·贝克，医学博士，宾夕法尼亚大学精神病学教授
“If you have trouble with social anxiety, you will find the book by Drs. Antony and Swinson to be an excellent resource. This highly experienced duo has provided an excellent road map to guide you through your efforts to overcome your anxiety and improve the quality of your life. Based on the tried and true methods of cognitive-behavioral therapy and on the results of many scientific studies, the techniques described in this book will help you feel better when you are with other people or the center of attention. The only thing you have to do is work hard and apply them. Best wishes for your journey along that road.” “如果你在社交焦虑方面有困扰，你会发现 Antony 博士和 Swinson 博士的这本书是一个极好的资源。这对经验丰富的搭档为你提供了一张出色的路线图，指导你克服焦虑、提升生活质量。基于经过验证的认知行为疗法方法和众多科学研究的成果，本书中描述的技巧将帮助你在与他人相处或成为关注焦点时感觉更好。你唯一需要做的就是努力并加以应用。祝你在这条道路上的旅程顺利。”
-Richard Heimberg, Ph.D., director of the Adult Anxiety Clinic of Temple University, Philadelphia - 理查德·海姆伯格博士，费城天普大学成人焦虑诊所主任
“Drs. Antony and Swinson provide practical advice in a highly readable format. This book will be invaluable to people whose social anxiety prevents them from leading full and happy lives.” “Antony 博士和 Swinson 博士以高度易读的形式提供了实用建议。这本书对于那些因社交焦虑而无法过上充实快乐生活的人来说，将是无价的帮助。”
-Murray B. Stein, MD, professor of psychiatry and director of anxiety and traumatic stress disorders program at the University of California, San Diego - 默里·B·斯坦医学博士，加州大学圣地亚哥分校精神病学教授及焦虑与创伤应激障碍项目主任
“This is an excellent resource written by world-renowned and skilled clinicians and researchers in the area of anxiety disorders. Drs. Antony and Swinson present the most up-to-date information about social anxiety and its treatment in a way that is clear and, most importantly, that provides step-by-step tools for overcoming this disorder. This is a must-read for persons suffering with social anxiety.” “这是一本由世界知名且经验丰富的焦虑症领域临床医生和研究人员撰写的优秀资源。Antony 博士和 Swinson 博士以清晰的方式呈现了关于社交焦虑及其治疗的最新信息，最重要的是，提供了逐步克服该障碍的工具。这是社交焦虑患者必读的书籍。”
-Michelle G. Craske, Ph.D., professor of psychology at the University of California, Los Angeles ——加州大学洛杉矶分校心理学教授 Michelle G. Craske 博士
“This workbook by Antony and Swinson gives the millions of people whose lives are limited by social fears the hope to control their future. The book is clear, practical, easy to follow, and, above all, based on solid, scientific ground. The sections on troubleshooting are especially valuable to really help fine-tune the techniques. I would strongly recommend this book to anyone who is serious about overcoming their social fears.” “Antony 和 Swinson 的这本工作手册为数以百万计因社交恐惧而生活受限的人们带来了掌控未来的希望。该书内容清晰、实用、易于理解，最重要的是基于坚实的科学基础。关于故障排除的章节尤其宝贵，能够真正帮助细化技巧。我强烈推荐这本书给任何认真想要克服社交恐惧的人。”
-Ronald M. Rapee, Ph.D., professor of psychology at Macquarie University, Sydney, Australia, author of Overcoming Shyness and Social Phobia ——澳大利亚悉尼麦考瑞大学心理学教授 Ronald M. Rapee 博士，《克服害羞与社交恐惧》一书作者
“This volume, written by a team composed of a psychologist and a psychiatrist, is an outstanding workbook for any individual suffering from social anxiety or shyness and wishing to undertake a structured self-help program to overcome it. The book can be used alone or in conjunction with therapy. The authors are experts in their field and they offer strategies that are solidly grounded in the latest research literature. The workbook format provides readers with the exercises and worksheets they need to do the difficult work required to overcome their shyness and social anxiety.” 本书由一位心理学家和一位精神科医生组成的团队撰写，是任何遭受社交焦虑或害羞困扰并希望通过结构化自助计划克服这些问题的个人的杰出工作手册。该书既可单独使用，也可配合治疗使用。作者均为该领域的专家，提供的策略坚实地基于最新的研究文献。工作手册的形式为读者提供了完成克服害羞和社交焦虑所需的练习和工作表，帮助他们完成这项艰难的工作。
-Jacqueline B. Persons, Ph.D., director of the San Francisco Bay Area Center for Cognitive Therapy and clinical professor in the department of psychology at the University of California, Berkeley ——Jacqueline B. Persons 博士，旧金山湾区认知治疗中心主任，加州大学伯克利分校心理学系临床教授
^("The "){ }^{\text {The }} Shyness & Social Anxiety Workbook
SECOND EDITION ^("The "){ }^{\text {The }} 害羞与社交焦虑工作手册 第二版
PROVEN, STEP-BY-STEP TECHNIQUES FOR OVERCOMING YOUR FEAR 经过验证的逐步技术，助你克服恐惧
MARTIN M. ANTONY, PH.D. RICHARD P. SWINSON, MD 马丁·M·安东尼，博士 理查德·P·斯温森，医学博士
Publisher's Note 出版者声明
Care bas been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the contents of the publication. 我们已尽力确认所提供信息的准确性，并描述普遍接受的做法。然而，作者、编辑和出版方不对本书中信息的错误或遗漏承担责任，也不对因应用本书信息而产生的任何后果负责，且对本出版物内容不作任何明示或暗示的保证。
The authors, editors, and publisher bave exerted every effort to ensure that any drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. 作者、编辑和出版方已尽一切努力确保本书中所述的药物选择和剂量符合出版时的现行建议和实践。然而，鉴于持续的研究、政府法规的变化以及与药物治疗和药物反应相关信息的不断更新，读者应查阅每种药物的包装说明书，以了解适应症和剂量的任何变更以及新增的警告和注意事项。当推荐的药物是新药或不常用药时，这一点尤为重要。
Some drugs and medical devices presented in this publication may bave Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the bealth care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. 本出版物中介绍的某些药物和医疗器械可能已获得美国食品药品监督管理局（FDA）批准，仅限于受限的研究环境中使用。医疗服务提供者有责任确认其临床实践中计划使用的每种药物或器械的 FDA 状态。
Distributed in Canada by Raincoast Books 由 Raincoast Books 在加拿大发行
Library of Congress Cataloging-in-Publication Data 国会图书馆出版目录数据
Antony, Martin M. 安东尼，马丁·M.
The shyness and social anxiety workbook: proven, step-by-step techniques for overcoming your fear / Martin M. Antony and Richard P. Swinson. – 2nd ed. 害羞与社交焦虑工作手册：克服恐惧的经过验证的逐步技巧 / 马丁·M. 安东尼 和 理查德·P. 斯温森 著。– 第二版。
p. cm. 页码。厘米。
Rev. ed. of: The shyness & social anxiety workbook. 修订版：《害羞与社交焦虑工作手册》。
Includes bibliographical references (p. ). 包含参考书目（第 页）。
ISBN-13: 978-1-57224-553-2 (pbk. : alk. paper) ISBN-13：978-1-57224-553-2（平装：碱性纸）
ISBN-10: 1-57224-553-0 (pbk. : alk. paper) 1. Bashfulness–Problems, exercises, etc. 2. Social phobia–Problems, exercises, etc. I. Swinson, Richard P. II. Antony, Martin M. Shyness & social anxiety workbook. III. Title. ISBN-10：1-57224-553-0（平装：碱性纸） 1. 害羞——问题、练习等 2. 社交恐惧症——问题、练习等 I. Swinson, Richard P. II. Antony, Martin M. 害羞与社交焦虑工作手册 III. 书名。
BF575.B3A58 2008
158.2–dc22
For our students. 为了我们的学生。
-MMA and RPS -MMA 和 RPS
Contents 目录
Acknowledgments … vii 致谢 … vii
Introduction … I 引言 … I
Part I Understanding Your Social Anxiety 第一部分 理解你的社交焦虑
Chapter 1 Shyness and Social Anxiety … 5 第一章 害羞与社交焦虑 … 5
Chapter 2 Why Do You Have These Fears? … 29 第 2 章 你为什么会有这些恐惧？ … 29
Chapter 3 Getting to Know Your Social Anxiety … 39 第 3 章 了解你的社交焦虑 … 39
Part 2 How to Overcome Social Anxiety and Enjoy Your Life 第二部分 如何克服社交焦虑，享受生活
Chapter 4 Making a Plan for Change … 65 第 4 章 制定改变计划 … 65
Chapter 5 Medications for Social Anxiety and Social Anxiety Disorder … 93 第 5 章 社交焦虑和社交焦虑障碍的药物治疗 …… 93
Chapter 6 Changing Your Anxious Thoughts and Expectations … 107 第 6 章 改变你的焦虑思维和期望 …… 107
Chapter 7 Confronting Your Fears Through Exposure … 143 第 7 章 通过暴露面对你的恐惧 …… 143
Chapter 8 Exposure to Social Situations … 165 第 8 章 暴露于社交情境 …… 165
Chapter 9 Exposure to Uncomfortable Sensations … 191 第 9 章 暴露于不适感受 … 191
Chapter 10 Communicating More Effectively … 203 第 10 章 更有效的沟通 … 203
Chapter II Maintaining Your Improvements and Planning for the Future … 233 第 11 章 维持你的进步与未来规划 … 233
Recommended Readings … 239 推荐阅读 … 239
National and International Associations Providing Referrals … 245 国家和国际协会提供的转介……245
Internet Resources … 249 互联网资源……249
References … 251 参考文献……251
Acknowledgments 致谢
There are many people without whom this workbook would not have been possible. First, we wish to acknowledge those who were instrumental in developing and investigating the treatments described in this book. Dr. Aaron T. Beck pioneered many of the cognitive strategies that are used throughout the world to treat anxiety, depression, and many other conditions. We are also indebted to Drs. Isaac Marks, S. Rachman, Joseph Wolpe, David Barlow, and others who helped to develop and study the exposure-based strategies that are now commonplace for the treatment of anxiety. We also acknowledge the important contributions of Drs. Richard Heimberg, Samuel Turner, Deborah Beidel, David M. Clark, and others who adapted these cognitive and behavioral methods for the treatment of social anxiety. 有许多人使得本工作手册成为可能。首先，我们要感谢那些在开发和研究本书所述治疗方法中起关键作用的人。Aaron T. Beck 博士开创了许多认知策略，这些策略现已被全球广泛用于治疗焦虑、抑郁及许多其他疾病。我们还要感谢 Isaac Marks 博士、S. Rachman 博士、Joseph Wolpe 博士、David Barlow 博士及其他帮助开发和研究基于暴露的策略的人，这些策略现已成为治疗焦虑的常用方法。我们同样感谢 Richard Heimberg 博士、Samuel Turner 博士、Deborah Beidel 博士、David M. Clark 博士及其他将这些认知和行为方法改编用于治疗社交焦虑的重要贡献者。
A special thank-you goes out to our colleagues, clients, and patients who provided many helpful suggestions over the years that informed this second edition of The Shyness and Social Anxiety Workbook. Finally, we wish to express our gratitude to the staff at New Harbinger Publications (including Carole Honeychurch, Matthew McKay, Catharine Sutker, Amy Shoup, Dorothy Smyk, and many others), who worked closely with us through all stages of developing, editing, and marketing this book. 特别感谢多年来为《害羞与社交焦虑工作手册》第二版提供许多宝贵建议的同事、客户和患者。最后，我们要感谢 New Harbinger Publications 的工作人员（包括 Carole Honeychurch、Matthew McKay、Catharine Sutker、Amy Shoup、Dorothy Smyk 及其他许多人），他们在本书的开发、编辑和营销各个阶段与我们紧密合作。
Introduction 引言
Shyness and social anxiety are universal. From time to time, almost everyone has felt nervous speaking in front of a group or anxious when interacting with another person. We wonder if a presentation has gone well or whether we have made a good impression on a first date or a job interview. In fact, even some celebrities, who make their living in the public eye, have been described as excessively shy from time to time, including Harrison Ford (actor), Mary Chapin Carpenter (singer), Michelle Pfeiffer (actor), David Bowie (rock star), David Letterman (talk-show host), Nicole Kidman (actor), and Carrie Underwood (American Idol winner). There have also been reports in the media about musical performers like Barbra Streisand, Carly Simon, and Donny Osmond suffering from performance anxiety. Even radio “shock jock” Howard Stern has described himself as being painfully shy when he is outside the safe confines of his on-air studio. (FYI, details on other shy celebrities can be found at www.shakeyourshyness.com/shypeople htm.) 害羞和社交焦虑是普遍存在的。几乎每个人都会时不时地在众人面前发言时感到紧张，或在与他人互动时感到焦虑。我们会想知道一次演讲是否顺利，或者我们在第一次约会或工作面试中是否留下了好印象。事实上，即使是一些以公众形象为生的名人，也时常被描述为过度害羞，包括哈里森·福特（演员）、玛丽·查平·卡彭特（歌手）、米歇尔·菲佛（演员）、大卫·鲍伊（摇滚明星）、大卫·莱特曼（脱口秀主持人）、妮可·基德曼（演员）和凯莉·安德伍德（美国偶像冠军）。媒体也报道过一些音乐表演者如芭芭拉·史翠珊、卡莉·西蒙和唐尼·奥斯蒙德患有表演焦虑。即使是广播“震撼主播”霍华德·斯特恩也曾形容自己在离开安全的广播录音室时会感到极度害羞。（供参考，关于其他害羞名人的详细信息可见 www.shakeyourshyness.com/shypeople.htm。）
Shyness and social anxiety can range in intensity from being fairly mild to completely incapacitating. In extreme cases, social anxiety may prevent an individual from developing friendships, working, or even standing in a public place. Regardless of whether your fears are minor or completely overwhelming, the strategies described in this book will help you to deal more effectively with social anxiety. 害羞和社交焦虑的强度可以从相当轻微到完全丧失能力不等。在极端情况下，社交焦虑可能会阻止一个人建立友谊、工作，甚至在公共场所站立。无论你的恐惧是轻微的还是完全压倒性的，本书中描述的策略都将帮助你更有效地应对社交焦虑。
We recommend that you read this workbook in the order in which the chapters appear. The initial chapters are designed to educate you about the nature of social anxiety and to teach you how to evaluate the main features of your own social anxiety. Then we discuss the costs and benefits of different treatment approaches and help you to select among available treatment options. Subsequent chapters provide detailed information about particular treatment strategies including medications, cognitive therapy for changing your anxious thoughts, using exposure to confront the situations you fear, and 我们建议你按照章节顺序阅读本练习册。最初的章节旨在让你了解社交焦虑的本质，并教你如何评估自己社交焦虑的主要特征。接着，我们讨论不同治疗方法的利弊，并帮助你在可用的治疗选项中做出选择。后续章节提供了关于特定治疗策略的详细信息，包括药物治疗、改变焦虑思维的认知疗法、通过暴露法面对你害怕的情境，以及
fine-tuning your communication and performance skills. The final chapter of the book discusses strategies for maintaining your improvements. 微调你的沟通和表现技巧。本书的最后一章讨论了保持你进步的策略。
This book is different from other self-help books in a number of ways. Of the many books on social anxiety and shyness that you will find in your local bookstore, this was the first to be written in a workbook format. It is filled with exercises and practices designed to teach you basic strategies for overcoming shyness and social anxiety. We encourage you to fill in the blank worksheets and forms located throughout the text. In addition, we encourage you to make copies of the forms for your personal use so you can continue to use them over the coming months. 本书在许多方面不同于其他自助书籍。在你当地的书店里，你会发现许多关于社交焦虑和害羞的书籍，而这是第一本以工作手册形式编写的书。书中充满了旨在教你克服害羞和社交焦虑的基本策略的练习和实践。我们鼓励你填写书中各处的空白工作表和表格。此外，我们鼓励你复印这些表格以供个人使用，这样你可以在未来几个月继续使用它们。
This book also differs from many others because the strategies we recommend have all been investigated extensively in well-designed clinical studies. In addition to specializing in helping people deal more effectively with their anxiety, we also are actively involved in research on the nature and treatment of anxiety. It is a well-established fact that when the techniques described in this book are used in a therapeutic setting, people generally experience a significant decrease in their social and performance anxiety (Rodebaugh, Holaway, and Heimberg 2004). Essentially, we have taken strategies that have proven to be useful in therapy and adapted them into a self-help format. Recently, investigators have also shown that our self-help approach (using the first edition of this book) can also be effective for reducing social anxiety (Moore, Braddock, and Abramowitz 2007). This workbook is designed so that it can be used alone or coupled with regular visits to a professional therapist. In fact, a motive for writing this book was to have a good reference our own clients and patients can use as they progress through therapy. 本书与许多其他书籍不同之处在于，我们推荐的策略都经过了精心设计的临床研究的广泛验证。除了专注于帮助人们更有效地应对焦虑外，我们还积极参与关于焦虑的本质及其治疗的研究。一个公认的事实是，当在治疗环境中使用本书中描述的技术时，人们通常会显著减少社交和表现焦虑（Rodebaugh、Holaway 和 Heimberg，2004）。本质上，我们将已被证明在治疗中有效的策略改编成了自助形式。最近，研究人员还表明，我们的自助方法（使用本书第一版）也能有效减少社交焦虑（Moore、Braddock 和 Abramowitz，2007）。本工作手册设计为既可单独使用，也可配合定期访问专业治疗师使用。事实上，写作本书的一个动机是为我们的客户和患者提供一个良好的参考，帮助他们在治疗过程中使用。
This second edition has been thoroughly updated with the latest scientific knowledge and references concerning the nature and treatment of social anxiety (for example, the section on the genetic underpinnings of social anxiety now includes a discussion of the Human Genome Project, which hadn’t been completed when the first edition was published). The chapter on medications has also been revised to include the latest information on medications that have only recently been studied for treatment of social anxiety. Sections that were previously unclear or out of date have been completely rewritten. We have added many new examples and several forms and diaries have been updated and simplified. New sections have been added as well, including a discussion of strategies for improving motivation for treatment and sections for family members and friends of people who suffer from social anxiety. Finally, the lists of recommended readings and Internet resources have been thoroughly updated. 第二版全面更新了关于社交焦虑的本质和治疗的最新科学知识和参考资料（例如，关于社交焦虑遗传基础的章节现在包括了对人类基因组计划的讨论，而该计划在第一版出版时尚未完成）。药物章节也进行了修订，纳入了最近才开始研究用于治疗社交焦虑的药物的最新信息。之前不清晰或过时的部分已被完全重写。我们添加了许多新的例子，并更新和简化了若干表格和日记。还新增了若干章节，包括关于提高治疗动机的策略讨论，以及为社交焦虑患者的家人和朋友设立的章节。最后，推荐阅读书目和互联网资源列表也进行了全面更新。
The journey to overcoming your shyness and social anxiety may not be an easy one. Some aspects of your fear will be easier and quicker to overcome than others. Also, for every two or three steps forward, you may experience what feels like a step back. Nevertheless, the techniques described in this book have been shown to reduce social and performance fears in most people who use them consistently. With hard work and perseverance, these strategies will provide you with the opportunity to make big, positive changes in your life. 克服害羞和社交焦虑的旅程可能并不容易。你害怕的某些方面会比其他方面更容易、更快地克服。此外，每前进两三步，你可能会感觉像是后退了一步。尽管如此，本书中描述的技巧已被证明能在大多数坚持使用它们的人身上减少社交和表现恐惧。通过努力和坚持，这些策略将为你提供机会，在生活中做出重大而积极的改变。
PART 1 第一部分
Understanding Your Social Anxiety 理解你的社交焦虑
CHAPTER 1 第一章
Shyness and Social Anxiety 害羞与社交焦虑
Rachel was a twenty-six-year-old woman who worked as an assistant manager of a small bookstore. She was referred to our Anxiety Treatment and Research Centre to get help for intense anxiety about her upcoming wedding. Rachel wasn’t afraid of being married; in fact, she looked forward to spending years together with her husband. She was terrified of the wedding itself. The idea of being on display in front of such a large audience was almost unthinkable. In fact, she had postponed her wedding twice before because of her fear of being the center of attention. 瑞秋是一位二十六岁的女性，在一家小型书店担任助理经理。她被推荐到我们的焦虑治疗与研究中心，寻求对即将到来的婚礼所引发的强烈焦虑的帮助。瑞秋并不害怕结婚；事实上，她期待着与丈夫共度多年时光。她害怕的是婚礼本身。想到要在如此众多观众面前成为焦点，几乎让她难以承受。事实上，她因为害怕成为关注的中心，已经两次推迟了婚礼。
Rachel’s anxiety involved more than just a fear of her wedding. She reported that she’d always been shy, even when she was very young. When she was in high school, her anxiety around people had become so intense that it was affecting her school life. She was convinced that her classmates would find her dull or boring, or that they would notice her anxiety and assume that she was incompetent. Typically, Rachel avoided doing oral reports at school and didn’t take any classes where she felt her performance might be observed or judged by her classmates (such as physical education). On a few occasions, she even asked for special permission to hand in a written essay instead of doing a presentation in front of the class. Despite being an excellent student, she generally tended to be very quiet in class and rarely asked questions or participated in class discussions. 瑞秋的焦虑不仅仅是对婚礼的恐惧。她说自己从小就很害羞。上高中时，她对人群的焦虑变得非常强烈，影响到了她的学校生活。她坚信同学们会觉得她无聊或乏味，或者会注意到她的焦虑，从而认为她无能。通常，瑞秋避免在学校做口头报告，也不选那些她觉得同学可能会观察或评判她表现的课程（比如体育课）。有几次，她甚至请求特别许可，允许她交一篇书面论文，而不是在全班面前做演讲。尽管她是个优秀的学生，但她通常在课堂上非常安静，很少提问或参与课堂讨论。
Throughout college, Rachel found it difficult to make new friends. Although people enjoyed her company and often invited her to parties and other social events, she rarely accepted the invitations. She had a long list of excuses to get out of socializing with other people. She was comfortable only with her family and a few longtime friends, but aside from those, she usually avoided contact with other people. 在大学期间，瑞秋发现结交新朋友很困难。虽然人们喜欢和她相处，经常邀请她参加聚会和其他社交活动，但她很少接受这些邀请。她总能找到各种借口来避免与他人社交。她只在家人和几个老朋友面前感到自在，除此之外，她通常避免与其他人接触。
After college, Rachel began working at a bookstore, and after a short time, she was promoted to assistant manager. She was always comfortable dealing with customers at her store, and she gradually became more comfortable talking to her coworkers. 大学毕业后，瑞秋开始在一家书店工作，不久后被提升为助理经理。她在店里与顾客打交道时总是感到自在，渐渐地，她也开始更习惯与同事交谈。
However, she avoided eating lunch with other staff members, and she never attended any social events, including the company’s annual holiday party. 然而，她避免与其他员工一起吃午饭，也从未参加过任何社交活动，包括公司的年度假日派对。
Rachel lived with her social anxiety for years, despite how it interfered with her education, work, and social life. It was not until the anxiety prevented her from having the kind of wedding she and her fiancé wanted that she decided to seek help. 尽管社交焦虑影响了她的学习、工作和社交生活，瑞秋还是与之共处了多年。直到焦虑阻碍了她和未婚夫举办理想婚礼时，她才决定寻求帮助。
Rachel’s story is not that different from those of other people who experience intense feelings of shyness, social anxiety, and performance-related fears. The types of anxious beliefs and behaviors that she reported are similar to those that many socially anxious people describe. After her evaluation at our center, Rachel began a twelvesession course of cognitive behavioral therapy (CBT) and gradually learned to cope with her anxiety more effectively. By the end of treatment, her avoidance of social situations had decreased significantly, and Rachel was much more comfortable in situations that previously made her very anxious. 瑞秋的故事与其他经历强烈害羞感、社交焦虑和表演相关恐惧的人们的故事并无太大不同。她所报告的焦虑信念和行为类型与许多社交焦虑者描述的相似。在我们中心的评估之后，瑞秋开始了为期十二次的认知行为疗法（CBT）课程，并逐渐学会更有效地应对她的焦虑。治疗结束时，她对社交场合的回避显著减少，瑞秋在以前让她非常焦虑的情境中也变得更加自如。
CBT involves (1) identifying the thought patterns and behaviors that contribute to people’s negative feelings, such as anxiety, and (2) teaching people new ways of thinking and behaving to better manage their anxiety. This book will teach you the strategies commonly used in CBT for social anxiety. Before exploring those strategies, however, we will begin this chapter in the same way we usually begin treatment with the individuals we see in our program - with an overview of the nature of fear and anxiety in general, and of social anxiety in particular. 认知行为疗法包括（1）识别导致人们负面情绪（如焦虑）的思维模式和行为，以及（2）教导人们新的思维和行为方式，以更好地管理他们的焦虑。本书将教你社交焦虑中常用的认知行为疗法策略。然而，在探讨这些策略之前，我们将以我们项目中通常开始治疗的方式开启本章——概述恐惧和焦虑的本质，特别是社交焦虑的本质。
ANXIETY, WORRY, FEAR, AND PANIC 焦虑、担忧、恐惧与惊慌
Everyone knows what it feels like to be afraid. Fear is a basic human emotion. In humans, fear is controlled, in part, by an area of the brain called the limbic system. The limbic system includes some of the deepest, most primitive structures of the brain-structures shared by many less “evolved” animals. In fact, there is reason to believe that the emotion of fear is present across most, if not all, animal species. Most organisms display specific patterns of behavior when confronted with danger and often these “fearful” behaviors include forms of aggression or escape. Therefore, the intense feelings we experience when we are exposed to an immediate danger often are called the “fight-or-flight” response. 每个人都知道害怕的感觉。恐惧是一种基本的人类情感。在人类中，恐惧部分由大脑中的一个区域——边缘系统控制。边缘系统包括大脑中一些最深层、最原始的结构——这些结构在许多较不“进化”的动物中也存在。事实上，有理由相信恐惧这种情感存在于大多数甚至所有动物物种中。大多数生物在面对危险时会表现出特定的行为模式，这些“恐惧”行为通常包括攻击或逃跑的形式。因此，当我们暴露于直接危险时所体验到的强烈感受，通常被称为“战斗或逃跑”反应。
Although most people use the terms “anxiety” and “fear” interchangeably, behavioral scientists who study emotions assign somewhat different meanings to these and other related terms (Barlow 2002; Suárez et al., in press). Anxiety is a future-oriented feeling of dread or apprehension associated with the sense that events are both uncontrollable and unpredictable. In other words, anxiety is a nagging feeling that occurs when a person believes a negative event may occur in the future and that nothing can be done to prevent it. 虽然大多数人将“焦虑”和“恐惧”这两个词交替使用，但研究情绪的行为科学家对这些及其他相关术语赋予了略有不同的含义（Barlow 2002；Suárez 等，待发表）。焦虑是一种面向未来的恐惧或忧虑感，伴随着对事件既无法控制又无法预测的感觉。换句话说，焦虑是一种挥之不去的感觉，当一个人相信未来可能会发生负面事件且无能为力阻止时，这种感觉便会出现。
People who feel anxious tend to dwell upon and ruminate about the possibility of danger. This tendency to dwell on future negative events is called worry. Anxiety is also associated with uncomfortable physical feelings such as arousal (for example, sweatiness, increased pulse), tension (for instance, tight muscles), and pain (like headaches). 感到焦虑的人往往会反复思考和沉溺于危险的可能性。这种对未来负面事件反复思考的倾向被称为担忧。焦虑还伴随着不适的身体感觉，如唤醒状态（例如出汗、心跳加快）、紧张（例如肌肉紧绷）和疼痛（如头痛）。
There is no question that when anxiety is too intense it can interfere with performance; however, mild to moderate amounts of anxiety are actually helpful. If you never became even slightly anxious under any circumstances, you probably wouldn’t bother doing the things that must be done. Why would you bother preparing an assignment on time, dressing nicely for a date, or eating healthy food if you weren’t concerned about the consequences of not doing these things? In part, it is anxiety that motivates us to work hard, prepare for challenges, and protect ourselves from possible threats. 毫无疑问，当焦虑过于强烈时，它会干扰表现；然而，轻度到中度的焦虑实际上是有帮助的。如果你在任何情况下都从未感到哪怕一点点焦虑，你可能根本不会去做那些必须完成的事情。如果你不在意不做这些事情的后果，为什么还要按时准备作业、为约会穿得体面，或者吃健康的食物呢？部分原因是，焦虑激励我们努力工作、为挑战做准备，并保护自己免受可能的威胁。
In contrast to anxiety, fear is a basic emotion that occurs when an individual is confronted with an immediate real or imagined danger. Fear leads to a sudden, intense physiological alarm reaction that essentially has one purpose-to get the person away from the danger as quickly as possible. When people feel fearful, their bodies go into overdrive to ensure that escape is fast and successful. Heart rate and blood pressure increase to transfer blood to the large muscles. Breathing quickens to improve the flow of oxygen throughout the body. People sweat to cool off the body and perform more efficiently. In fact, all of these symptoms of arousal and fear are designed to make escape easier, allowing for survival in the face of danger. 与焦虑不同，恐惧是一种基本情绪，当个体面临即时的真实或想象中的危险时产生。恐惧会引发一种突然且强烈的生理警报反应，其本质目的是让人尽快远离危险。当人们感到恐惧时，身体会进入超负荷状态，以确保逃脱迅速且成功。心率和血压升高，将血液输送到大肌肉群。呼吸加快，以改善全身的氧气流动。人们出汗以冷却身体，提高身体的工作效率。事实上，所有这些唤醒和恐惧的症状都是为了使逃脱更容易，从而在面对危险时生存下来。
Panic attack is the clinical term used to describe the experience of intense fear that takes place even though no realistic danger is actually present. Panic attacks can be triggered by specific situations that people fear (for example, giving an oral presentation, being in a high place, seeing a snake) or they sometimes occur out of the blue, without any obvious trigger. Panic attacks are discussed in more detail later in this chapter. 惊恐发作是临床术语，用来描述即使没有实际危险存在时，个体仍经历的强烈恐惧感。惊恐发作可能由人们害怕的特定情境触发（例如，做口头报告、处于高处、看到蛇），有时也会无明显诱因突然发生。本章后面将更详细地讨论惊恐发作。
To summarize, fear is an emotional reaction to an immediate danger, whereas anxiety is a state of apprehension about some future threat. For example, worrying about giving a presentation that is a week away is a reflection of anxiety, whereas experiencing an adrenaline rush while in the midst of giving a presentation is usually an example of fear. 总之，恐惧是对眼前危险的情绪反应，而焦虑则是对未来某种威胁的担忧状态。例如，担心一周后要做的演讲反映的是焦虑，而在演讲过程中体验到的肾上腺素激增通常是恐惧的表现。
Here are a few points to remember: 以下是几个需要记住的要点：
Anxiety and fear are normal emotions everyone experiences from time to time. 焦虑和恐惧是每个人时不时都会经历的正常情绪。
Anxiety and fear are time-limited. Even though they feel as though they may continue forever, they always decrease over time. 焦虑和恐惧都是有时间限制的。尽管它们感觉像会永远持续，但它们总会随着时间的推移而减弱。
Anxiety and fear have a helpful function in that they prepare you for future threats and protect you from danger. So, your goal should not be to rid yourself of all fear and anxiety. Rather, your goal should be to reduce your anxiety to a level that no longer interferes significantly with your life. 焦虑和恐惧具有有益的功能，因为它们帮助你为未来的威胁做好准备，并保护你免受危险。因此，你的目标不应是完全摆脱所有的恐惧和焦虑。相反，你的目标应该是将焦虑降低到不再显著干扰你生活的程度。
WHAT IS A SOCIAL SITUATION? 什么是社交情境？
A social situation is any situation in which you and other people are present. Social situations can include those that involve interacting with others (these are often referred to 社交场合是指你和其他人同时在场的任何情境。社交场合可以包括那些涉及与他人互动的情境（这些通常被称为
as interpersonal situations) or situations in which you are the focus of attention or might be noticed by others (these are often called performance situations). Examples of interpersonal situations and performance situations that may be feared by people with high levels of social anxiety include: （如人际交往情境）或你成为关注焦点或可能被他人注意到的情境（这些通常被称为表演情境）。具有高度社交焦虑的人可能害怕的人际交往情境和表演情境的例子包括：
Interpersonal Situations 人际交往情境
Asking someone out on a date 约某人出去约会
Talking to someone in authority 与有权威的人交谈
Initiating or maintaining a conversation 开始或维持一段对话
Going to a party 参加聚会
Having friends over for dinner 邀请朋友来家里吃饭
Meeting new people 结识新朋友
Talking on the telephone 打电话
Expressing a personal opinion 表达个人观点
Having a job interview 参加工作面试
Being assertive (for example, saying no when you don’t want to do something) 表现出自信（例如，当你不想做某事时说“不”）
Returning an item to a store 将商品退回商店
Sending back food in a restaurant 在餐厅退回食物
Making eye contact 进行眼神交流
Performance Situations 表现场合
Public speaking 公开演讲
Speaking in meetings 会议发言
Playing sports or participating in aerobics 参加体育运动或有氧运动
Performing a piano recital in front of others 在别人面前进行钢琴独奏
Having others watch you work 让别人观看你工作
Leaving a recorded message on somebody’s voice mail 在某人的语音信箱上留言
Getting married 结婚
Acting on a stage 在舞台上表演
Reading out loud in front of others 在别人面前大声朗读
Eating or drinking in front of others 在别人面前吃东西或喝东西
Using public bathrooms with others in the room 在公共厕所里有人时使用厕所
Writing with others watching (for example, completing a form in public) 在别人注视下写东西（例如，在公共场合填写表格）
Making a mistake in public (for example, falling down, dropping your keys, and so on) 在公共场合犯错（例如，摔倒、掉钥匙等）
Walking or jogging on a busy street or some other public place 在人多的街道或其他公共场所走路或慢跑
Introducing yourself to a group of people 向一群人介绍自己
Shopping in a busy store 在繁忙的商店购物
WHAT IS SOCIAL ANXIETY? 什么是社交焦虑？
Social anxiety refers to nervousness or discomfort in social situations, usually because of fear about doing something embarrassing or foolish, making a bad impression, or being judged critically by others. For many people, social anxiety is limited to certain types of social situations. For example, some people are very uncomfortable in formal workrelated situations, like presentations and meetings, but are quite comfortable in more casual situations, like parties and socializing with friends. Others may show the exact opposite pattern, with formal work situations being easier than unstructured social gatherings. In fact, it’s not unusual to hear of a celebrity who is quite comfortable performing in front of large audiences but who otherwise feels shy and nervous when interacting with people one-on-one or in small groups. 社交焦虑是指在社交场合中感到紧张或不适，通常是因为害怕做出尴尬或愚蠢的事情，给人留下不好的印象，或被他人严厉评判。对许多人来说，社交焦虑仅限于某些类型的社交场合。例如，有些人在正式的工作相关场合，如演讲和会议中感到非常不自在，但在更随意的场合，如聚会和与朋友社交时则相当舒适。另一些人则表现出完全相反的模式，正式的工作场合比非结构化的社交聚会更容易应对。事实上，经常听说有些名人在大庭广众面前表演时非常自如，但在与人一对一或小团体互动时却感到害羞和紧张，这并不罕见。
The intensity of social anxiety and the range of feared social situations vary from person to person. For example, some people experience fear that is fairly manageable, whereas others are completely overwhelmed by the intensity of their fear. For some people, the fear is limited to a single social situation (for example, using public restrooms, public speaking), whereas for others, the social anxiety occurs in almost all social situations. 社交焦虑的强度和害怕的社交情境范围因人而异。例如，有些人经历的恐惧相对可控，而另一些人则被恐惧的强度完全压倒。对于某些人来说，恐惧仅限于单一的社交情境（例如，使用公共厕所、公开演讲），而对于另一些人来说，社交焦虑几乎出现在所有社交场合。
The experience of social anxiety is related to a number of common personality styles and traits including shyness, introversion, and perfectionism. People who are shy often feel uncomfortable in certain social situations, particularly when they involve interacting with others or meeting new people. People who are introverted tend to be quieter and more withdrawn in social situations and may prefer being alone, compared with people who are extroverted or outgoing. However, introverted people are not necessarily anxious or fearful when socializing. Finally, the trait of perfectionism is associated with a tendency to hold overly high standards for oneself that are difficult or impossible to meet. Perfectionism can lead people to feel anxious in public for fear that other people 社交焦虑的体验与多种常见的人格风格和特质有关，包括害羞、内向和完美主义。害羞的人在某些社交场合常常感到不自在，尤其是在与他人互动或结识新朋友时。内向的人在社交场合往往较为安静和内敛，可能更喜欢独处，相较于外向或活泼的人而言。然而，内向的人在社交时不一定会感到焦虑或害怕。最后，完美主义这一特质与对自己设定过高且难以达到的标准有关。完美主义可能导致人们在公共场合感到焦虑，担心别人会...
will notice their “flaws” and judge them negatively. Perfectionism is discussed again later in this chapter. 会注意到他们的“缺点”并对其进行负面评价。完美主义将在本章后面再次讨论。
HOW COMMON IS SOCIAL ANXIETY? 社交焦虑有多普遍？
It is difficult to obtain accurate estimates of the prevalence of social anxiety because different studies have tended to define social anxiety differently and used different questions when interviewing people about their anxiety. Nevertheless, researchers have consistently found that shyness and social anxiety are common experiences. For example, in a survey of more than 1,000 people from across the United States and elsewhere, psychologist Phillip Zimbardo and his colleagues (Carducci and Zimbardo 1995; Henderson and Zimbardo 1999; Zimbardo, Pilkonis, and Norwood 1975) found that 40 percent of those who were asked currently considered themselves to be chronically shy, to the point of it being a problem. Another 40 percent reported that they had previously considered themselves to be shy. Fifteen percent more considered themselves to be shy in some situations and only 5 percent reported that they were never shy. More recent surveys suggest that the prevalence of shyness may be even higher (for a review of studies on the prevalence of shyness, see Henderson and Zimbardo 1999). 由于不同研究对社交焦虑的定义各异，并且在访谈中使用了不同的问题，因此很难获得社交焦虑患病率的准确估计。然而，研究人员一致发现，害羞和社交焦虑是常见的体验。例如，在一项对来自美国及其他地区的 1000 多人的调查中，心理学家菲利普·津巴多及其同事（Carducci 和 Zimbardo 1995；Henderson 和 Zimbardo 1999；Zimbardo、Pilkonis 和 Norwood 1975）发现，40% 的受访者目前认为自己长期害羞，甚至到了成为问题的程度。另有 40% 报告说他们曾经认为自己害羞。15% 认为自己在某些情况下会害羞，只有 5% 报告说自己从不害羞。更近期的调查表明，害羞的患病率可能更高（关于害羞患病率研究的综述，见 Henderson 和 Zimbardo 1999）。
Researchers have also studied the prevalence of social anxiety disorder (a condition associated with extreme social anxiety that will be described later in this chapter). In a recently published survey of more than 9,000 Americans (Kessler et al. 2005), about 12 percent of people reported having the necessary symptoms to receive a diagnosis of social anxiety disorder at some point in their lives. In fact, social anxiety disorder was found to be the fourth most prevalent psychological problem in this study, after depression, alcohol abuse, and specific phobias (for example, phobias of animals, blood, needles, heights, flying, and so on). Other researchers have found the prevalence of social anxiety disorder to be lower than 12 percent, but almost all studies have confirmed that social anxiety disorder is a common problem (Kessler et al., in press). 研究人员还研究了社交焦虑症的患病率（这是一种与极端社交焦虑相关的疾病，稍后将在本章中描述）。在一项最近发表的针对 9000 多名美国人的调查中（Kessler 等，2005 年），约有 12%的人报告曾在其一生中的某个阶段出现了符合社交焦虑症诊断标准的症状。事实上，在这项研究中，社交焦虑症被发现是第四大常见的心理问题，仅次于抑郁症、酒精滥用和特定恐惧症（例如对动物、血液、针头、高处、飞行等的恐惧）。其他研究人员发现社交焦虑症的患病率低于 12%，但几乎所有研究都证实社交焦虑症是一个常见的问题（Kessler 等，待发表）。
Differences Between Men and Women 男女差异
Shyness and social anxiety are common across both sexes, although most studies have found that social anxiety disorder is slightly more prevalent in women than in men (Somers et al. 2006). There are a number of possible explanations for why women are more likely than men to report fearing social situations. First, it’s possible that men are actually more anxious in social situations than they are willing to admit. For example, there is evidence from studies of other phobias that men underestimate their levels of fear (Pierce and Kirkpatrick 1992). Also, in Western societies, women are often expected to be more socially active than men. Therefore, men may be able to avoid certain types of social situations more easily than women, without being harassed about their absence and without experiencing as much social pressure from others in their day-to-day lives. 害羞和社交焦虑在男女中都很常见，尽管大多数研究发现社交焦虑障碍在女性中的发病率略高于男性（Somers 等，2006）。女性比男性更可能报告害怕社交场合，有多种可能的解释。首先，男性在社交场合中实际上可能比他们愿意承认的更焦虑。例如，其他恐惧症的研究表明，男性往往低估自己的恐惧程度（Pierce 和 Kirkpatrick，1992）。此外，在西方社会中，女性通常被期望比男性更活跃于社交活动。因此，男性可能更容易避免某些类型的社交场合，而不会因缺席而受到骚扰，也不会在日常生活中感受到来自他人的过多社交压力。
There also may be differences in the types of social situations that men and women fear. One study found that men with social anxiety disorder were more fearful than women of urinating in public bathrooms and returning items to stores, whereas women with social anxiety disorder were more fearful than men of situations such as talking to people in authority, public speaking, being the center of attention, expressing disagreement, and throwing a party (Turk et al. 1998). 男性和女性在害怕的社交情境类型上也可能存在差异。一项研究发现，患有社交焦虑障碍的男性比女性更害怕在公共厕所小便和将物品退回商店，而患有社交焦虑障碍的女性则比男性更害怕与权威人士交谈、公开演讲、成为关注的焦点、表达异议以及举办聚会等情境（Turk 等，1998 年）。
Cultural Differences 文化差异
It is challenging to measure social anxiety across cultures because signs of social anxiety in one culture may have a very different meaning in another culture. For example, whereas some cultures may view poor eye contact as a sign of shyness or social anxiety, other cultures often avert their eyes from contact with another as an appropriate sign of respect. Cultures also differ with respect to their use of pauses and silence during conversation, the preferred physical distance from others, and the appropriate tone of voice (Sue 1990). 跨文化测量社交焦虑具有挑战性，因为一种文化中社交焦虑的表现可能在另一种文化中具有完全不同的含义。例如，某些文化可能将眼神接触不良视为害羞或社交焦虑的表现，而其他文化则常常避免与他人目光接触，作为一种适当的尊重表现。各文化在对话中的停顿和沉默使用、与他人的理想身体距离以及适当的语调方面也存在差异（Sue，1990 年）。
Despite the difficulties in measuring social anxiety across cultures, studies generally suggest that social anxiety and shyness are common across different ethnic groups. However, it should be noted that in the United States and Canada, the majority of people who seek treatment for social anxiety disorder tend to be white and have a European background. Although people from nonwhite, non-European backgrounds are just as likely to experience problems with social anxiety, they are less likely to seek help from a mental health professional. 尽管跨文化测量社交焦虑存在困难，研究普遍表明社交焦虑和害羞在不同族群中都很常见。然而，应注意的是，在美国和加拿大，寻求社交焦虑障碍治疗的人群大多数是白人且具有欧洲背景。虽然来自非白人、非欧洲背景的人同样可能经历社交焦虑问题，但他们较少寻求心理健康专业人士的帮助。
HOW DOES SOCIAL ANXIETY AFFECT PEOPLE'S LIVES? 社交焦虑如何影响人们的生活？
In this section, we will discuss how a person’s social anxiety can affect relationships, work and school, and other day-to-day activities. After reading each section, take a few moments to consider how your social anxiety affects each of these areas of your life, and then describe this in the space provided. 在本节中，我们将讨论一个人的社交焦虑如何影响人际关系、工作和学校以及其他日常活动。阅读每个部分后，请花几分钟时间思考你的社交焦虑如何影响你生活中的这些方面，然后在提供的空间中描述你的感受。
Relationships 人际关系
Social anxiety can make it difficult for people to establish and maintain healthy relationships. It can affect all levels of relationships, from those with strangers and casual acquaintances to those with family and significant others. For many people, even the most basic forms of social interaction (such as making small talk, asking other people for directions, saying hello to a neighbor) are very difficult. For such a person, dating 社交焦虑会使人们难以建立和维持健康的人际关系。它可以影响所有层次的关系，从与陌生人和普通熟人到与家人和重要他人的关系。对于许多人来说，即使是最基本的社交互动形式（如闲聊、向别人问路、向邻居打招呼）也非常困难。对于这样的人来说，约会
may be completely out of the question. Social anxiety may be more manageable around more familiar people, such as close friends and family-but not always. For some people, anxiety may actually increase as a relationship becomes more intimate. Also, social anxiety can interfere with existing relationships, particularly if a socially anxious person’s partner wants to socialize with others on a more regular basis. The following case examples illustrate how social anxiety can have a negative impact on a person’s relationships. 可能完全不在考虑范围内。社交焦虑在更熟悉的人群中，比如亲密的朋友和家人，可能更容易控制——但并非总是如此。对于某些人来说，随着关系变得更加亲密，焦虑实际上可能会增加。此外，社交焦虑还可能干扰现有的关系，特别是当一个社交焦虑者的伴侣希望更频繁地与他人社交时。以下案例说明了社交焦虑如何对一个人的人际关系产生负面影响。
William has never been in a romantic relationship. Although others have expressed interest in dating him, he always makes excuses not to go out and usually doesn’t return their phone calls. William desperately wants to be in a relationship, but he just can’t find the courage to take the initial steps. 威廉从未有过恋爱关系。尽管有人表示有兴趣与他约会，他总是找借口不出去，通常也不回他们的电话。威廉非常渴望拥有一段关系，但他就是找不到勇气迈出第一步。
Cindy is generally comfortable with her male colleagues at work, and she has several male friends with whom she socializes occasionally. However, as her relationships with men become closer, she is increasingly fearful that the other person will discover the “real” Cindy and reject her. She has ended several relationships with men just as they were becoming close. 辛迪在工作中通常对男同事感到自在，她也有几个偶尔社交的男性朋友。然而，随着她与男性的关系变得更亲密，她越来越害怕对方会发现“真实的”辛迪并拒绝她。她曾在几段关系刚要亲密时就结束了。
Jerry frequently argues with his girlfriend about his unwillingness to spend time with her friends. Although he was quite shy and anxious when they first started dating, recently his social anxiety has put more of a strain on their relationship. Because of his anxiety, they have been spending a lot of time alone while she has wanted to socialize as a couple with other people. 杰瑞经常因为不愿意和女朋友的朋友们一起出去而争吵。虽然他们刚开始交往时他相当害羞和焦虑，但最近他的社交焦虑给他们的关系带来了更多压力。由于他的焦虑，他们大部分时间都独处，而她则希望作为一对情侣与其他人社交。
Norm has gradually lost many of his friends over the years. For a while after finishing high school, he kept in touch with his closest friends. However, because of his anxiety, he often dreaded returning their calls and almost never accepted their invitations to get together. Eventually, his friends stopped calling him. 诺姆多年来逐渐失去了许多朋友。高中毕业后的一段时间里，他还与最亲密的朋友保持联系。然而，由于他的焦虑，他常常害怕接听他们的电话，几乎从不接受他们的聚会邀请。最终，他的朋友们停止了给他打电话。
Alison’s roommate consistently plays loud music after midnight, making it impossible for her to sleep. Despite feeling very frustrated and angry, Alison avoids asking her roommate to turn down her music for fear that her words won’t come out right or that her roommate will think she is an idiot. 艾莉森的室友总是在午夜后播放大声音乐，导致她无法入睡。尽管感到非常沮丧和愤怒，艾莉森还是避免让室友调低音乐音量，因为她害怕自己说不出合适的话，或者室友会认为她是个傻瓜。
When talking to people whom she doesn’t know well, Julia tends to speak very quietly, keep her distance, and avoid eye contact. As a result, people at work have started to leave her alone and they rarely invite her to lunch anymore. 当与不太熟悉的人交谈时，Julia 往往说话很轻声，保持距离，避免眼神接触。因此，工作中的人们开始不理她，也很少再邀请她一起吃午饭。
In the space below, record the ways in which social anxiety has affected your friendships and relationships. 在下面的空白处，记录社交焦虑如何影响了你的友谊和人际关系。
Education and Career 教育与职业
Significant social anxiety can have an impact on a person’s education and career. It can affect the types of courses you take in school and the types of jobs you might accept. It can also affect job performance as well as your enjoyment of school or work. Consider the following case examples: 严重的社交焦虑会影响一个人的教育和职业。它可能影响你在学校选择的课程类型以及你可能接受的工作类型。它还可能影响工作表现以及你对学校或工作的享受程度。请考虑以下案例示例：
Naveen turned down a promotion at work that involved significant supervisory responsibilities, including chairing a weekly staff meeting and training groups of staff. Although the promotion would have provided him with a significant increase in salary, Naveen was terrified of speaking in front of groups, and he couldn’t even imagine being able to lead the weekly meetings. 纳文拒绝了工作中的一次晋升机会，该职位涉及重要的监督职责，包括主持每周的员工会议和培训员工团队。尽管这次晋升会带来显著的薪资增长，纳文却害怕在群体面前讲话，他甚至无法想象自己能够主持每周的会议。
Ruth dropped out of college partway through her third year. As a freshman and sophomore, Ruth had been able to be anonymous in her large classes. However, when her classes became smaller in her junior year, she felt increased pressure to participate in class. She began avoiding her lectures and eventually left school. 露丝在大学三年级中途退学。大一和大二时，露丝在大班课中能够保持匿名。然而，当她进入三年级，班级变小后，她感受到参与课堂的压力增加。她开始逃避听讲座，最终离开了学校。
Len dreads going into work each day. He is terrified to speak to his coworkers and avoids speaking to his boss at all costs. Although he never misses work, Len keeps the time he must talk to others at a minimum. He rarely takes a break for fear that others will ask him to have lunch or to spend their breaks with him. 伦每天都害怕去上班。他害怕与同事交谈，尽一切可能避免与老板说话。虽然他从不缺勤，但伦尽量减少与他人交流的时间。他很少休息，害怕别人会邀请他共进午餐或一起休息。
Cheryl has been out of work for two years. Although she often hears of jobs that might be interesting, the thought of having to go through a formal interview is completely overwhelming. On several occasions she has arranged for job interviews and then failed to show up because of her social anxiety. Cheryl 已经失业两年了。虽然她经常听说一些可能有趣的工作，但一想到必须经历正式的面试就感到完全不知所措。她曾多次安排了面试，却因为社交焦虑而未能出现。
People at work think that Jason is a snob. He tends to be very serious, and he speaks very little to others. Even when someone asks him a question, he tends to answer with only one or two words. In reality, he isn’t a snob; he is just very shy and anxious around people at work. 同事们认为 Jason 是个势利眼。他往往非常严肃，与别人几乎不说话。即使有人问他问题，他也通常只用一两个字回答。实际上，他并不是势利眼；他只是在人多的工作环境中非常害羞和焦虑。
In the space below, record the ways in which social anxiety has affected your work or education. 请在下面的空白处记录社交焦虑如何影响了你的工作或学习。
Other Day-to-Day Activities 其他日常活动
Just about any activity that involves contact with other people can be affected by social anxiety. The following examples illustrate the range of situations and activities that are often difficult for people who are socially anxious. 几乎所有涉及与他人接触的活动都可能受到社交焦虑的影响。以下例子展示了那些对社交焦虑者来说常常感到困难的各种情境和活动。
Sita avoids going shopping on Saturdays because the stores are so crowded and she is fearful of having other people watch her. In fact, just walking down a busy street is sometimes difficult for her. 西塔避免在周六去购物，因为商店里人太多，她害怕被别人注视。事实上，仅仅是在繁忙的街道上行走，有时对她来说也很困难。
Michael screens all of his phone calls. He is very anxious when speaking to people on the phone because he finds it is more difficult to know how they are reacting to what he says as compared to speaking in person. 迈克尔筛选所有来电。他在电话中与人交谈时非常焦虑，因为他发现相比面对面交流，更难判断对方对他说的话的反应。
Kalinda has stopped going to the gym. She was finding that exercising in front of other people was causing her too much anxiety. Instead she exercises at home, where no one can see her. 卡琳达已经停止去健身房锻炼。她发现在人前锻炼让她感到过度焦虑。于是她改为在家锻炼，那里没有人能看到她。
Reid noticed a small hole in a sweater that he had just purchased. Although he had not worn the sweater and it still had all the original tags, he was unable to return the sweater for fear of looking foolish in front of the salesperson. 里德注意到他刚买的毛衣上有一个小洞。虽然他还没穿过这件毛衣，且毛衣上仍带有所有原始标签，但他因为害怕在售货员面前显得愚蠢，无法将毛衣退回。
In the space below, record the ways in which social anxiety has affected your day-to-day functioning. 在下面的空白处，记录社交焦虑如何影响了你的日常生活功能。
SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA) 社交焦虑障碍（社交恐惧症）
When social anxiety becomes particularly severe, it may develop into a condition known as social anxiety disorder. Social anxiety disorder (also called social phobia) is one of several anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association 2000). The DSM-IV-TR is the guide used by mental health practitioners to identify and diagnose various types of psychological problems. DSM-IV-TR diagnoses don’t tell us much about the causes of the disorder. Instead, the disorders listed in the DSM-IV-TR are simply descriptions of behaviors and experiences that cause interference or distress in a person’s life. In short, they are a way of classifying emotional and psychological problems. 当社交焦虑变得特别严重时，可能发展成一种称为社交焦虑障碍的状况。社交焦虑障碍（也称为社交恐惧症）是《精神障碍诊断与统计手册》第四版文本修订版（DSM-IV-TR；美国精神病学会 2000 年）中列出的几种焦虑障碍之一。DSM-IV-TR 是心理健康从业者用来识别和诊断各种心理问题的指南。DSM-IV-TR 的诊断并不能告诉我们疾病的具体原因。相反，DSM-IV-TR 中列出的障碍仅仅是对那些在个人生活中造成干扰或痛苦的行为和体验的描述。简而言之，它们是一种对情绪和心理问题的分类方式。
Although there is strong evidence that some of the DSM-IV-TR disorders (for example, schizophrenia, Alzheimer’s disease) are associated with a biological dysfunction, the evidence is much less clear for other disorders. The problems listed in the DSM-IV-TR range from severe mental illnesses to disorders that most people would consider “bad habits.” In fact, the DSM-IV-TR even includes such problems as nicotine dependence and impaired sleep resulting from jet lag or shift work. 尽管有强有力的证据表明某些 DSM-IV-TR 中的疾病（例如，精神分裂症、阿尔茨海默病）与生物功能障碍有关，但对于其他疾病的证据则不那么明确。DSM-IV-TR 中列出的问题范围从严重的精神疾病到大多数人认为的“坏习惯”。事实上，DSM-IV-TR 甚至包括了尼古丁依赖和因时差或轮班工作导致的睡眠障碍等问题。
If your anxiety symptoms meet the diagnostic criteria for social anxiety disorder, that does not mean that you are sick, have a disease, or are mentally ill. What it does mean is that you are experiencing social anxiety at a level that bothers you or interferes with aspects of your functioning. Remember that almost everyone experiences social anxiety, shyness, or performance anxiety from time to time. The social anxiety experienced by people with social anxiety disorder is associated with the same types of anxious thoughts and behaviors that most people experience. The difference is that people with social anxiety disorder experience social anxiety at a more intense level, more frequently, and often in a wider range of situations than people without social anxiety disorder. Fortunately, social anxiety disorder responds extremely well to the types of treatment discussed throughout this book. 如果你的焦虑症状符合社交焦虑障碍的诊断标准，这并不意味着你生病了、有疾病，或者精神有问题。它的含义是你正在经历一种让你感到困扰或干扰你某些功能的社交焦虑。请记住，几乎每个人都会时不时地经历社交焦虑、害羞或表演焦虑。患有社交焦虑障碍的人所经历的社交焦虑，与大多数人经历的焦虑思维和行为类型是相同的。不同之处在于，社交焦虑障碍患者经历的社交焦虑更为强烈、更频繁，且通常发生在比非社交焦虑障碍者更广泛的情境中。幸运的是，社交焦虑障碍对本书中讨论的各种治疗方法反应非常良好。
Diagnostic Criteria for Social Anxiety Disorder 社交焦虑障碍的诊断标准
A diagnosis of social anxiety disorder requires that a person have an intense and persistent fear of one or more social or performance situations. Typically, the fear is related to anxiety over being scrutinized by others or doing something embarrassing or humiliating. In addition, the fear must bother the individual or cause significant interference in his or her life. In other words, a person would not receive a diagnosis of social anxiety disorder if he or she had a strong fear of public speaking but didn’t need to speak in front of groups and didn’t care about having the fear. On the other hand, a person who fears public speaking and needs to speak in front of groups (for example, a schoolteacher) might be considered to have social anxiety disorder if the criteria are all met. 社交焦虑症的诊断要求个体对一种或多种社交或表演场合有强烈且持续的恐惧。通常，这种恐惧与害怕被他人审视或做出令人尴尬或羞辱的事情有关。此外，这种恐惧必须让个体感到困扰或在其生活中造成显著干扰。换句话说，如果一个人对公开演讲有强烈恐惧，但不需要在群体面前发言且不在意这种恐惧，他或她不会被诊断为社交焦虑症。另一方面，如果一个人害怕公开演讲且需要在群体面前发言（例如，学校教师），且满足所有诊断标准，则可能被认为患有社交焦虑症。
Social anxiety is often a feature of other problems. For example, people with eating disorders may be nervous about having other people notice their unusual eating habits. People who wash their hands excessively due to obsessive-compulsive disorder (OCD) may avoid people either for fear of being contaminated by others or for fear of having other people notice their OCD symptoms (such as frequent washing, red hands from washing, and so on). In these examples, the social anxiety would be viewed as part of the other problem, rather than as social anxiety disorder per se. For social anxiety disorder to be diagnosed as a separate problem, there must also be extreme social anxiety that is unrelated to any other problems that are present. For example, the person might have a general fear of looking stupid, appearing boring to others, or making mistakes in front of other people-over and above the anxiety about having others notice his or her compulsive washing or unusual eating habits. 社交焦虑常常是其他问题的一个表现。例如，患有饮食失调的人可能会因为担心别人注意到他们不寻常的饮食习惯而感到紧张。由于强迫症（OCD）而过度洗手的人，可能会因为害怕被他人污染或害怕别人注意到他们的强迫症状（如频繁洗手、因洗手而发红的手等）而避免与人接触。在这些例子中，社交焦虑被视为其他问题的一部分，而不是单独的社交焦虑症。要将社交焦虑症诊断为一个独立的问题，必须存在与其他问题无关的极端社交焦虑。例如，除了担心别人注意到其强迫性洗手或不寻常的饮食习惯外，该人可能还普遍害怕看起来愚蠢、在别人面前显得无聊或犯错。
Diagnosing social anxiety disorder is a complicated task. The information outlined in this section gives you an idea of how mental health professionals distinguish different types of problems from social anxiety disorder. However, this overview will probably not be enough for the purpose of self-diagnosis. If you want to be sure about whether your symptoms meet the diagnostic criteria for social anxiety disorder, we recommend that you see a psychiatrist or psychologist who has experience and expertise in the assessment of anxiety disorders. 诊断社交焦虑症是一项复杂的任务。本节中概述的信息可以让你了解心理健康专业人员如何区分不同类型的问题与社交焦虑症。然而，这个概述可能不足以用于自我诊断。如果你想确定自己的症状是否符合社交焦虑症的诊断标准，我们建议你咨询具有焦虑症评估经验和专业知识的精神科医生或心理学家。
Unfortunately, even professionals sometimes have difficulty agreeing about whether the diagnostic criteria for a particular disorder are met. For many people, the criteria outlined in the DSM-IV-TR don’t fit as neatly as we might like, which makes diagnosis especially challenging. Fortunately, the exact diagnosis isn’t always necessary for selecting an effective treatment. The strategies described in this book will be useful for overcoming shyness and performance anxiety regardless of whether the full criteria for social anxiety disorder are met. 不幸的是，即使是专业人士有时也难以就某一特定障碍的诊断标准是否符合达成一致。对于许多人来说，DSM-IV-TR 中列出的标准并不像我们希望的那样完全契合，这使得诊断尤其具有挑战性。幸运的是，选择有效治疗方法并不总是需要确切的诊断。本书中描述的策略对于克服害羞和表演焦虑都非常有用，无论是否完全符合社交焦虑症的诊断标准。
One final note about the diagnosis of social anxiety disorder: if all of the criteria for social anxiety disorder are met and the person is fearful of almost all social situations, the person is said to have generalized social anxiety disorder. 关于社交焦虑症诊断的最后一点说明：如果满足社交焦虑症的所有标准，并且该人几乎害怕所有社交场合，则称该人为广泛性社交焦虑症患者。
THREE COMPONENTS OF SOCIAL ANXIETY 社交焦虑的三个组成部分
In an effort to define shyness, Cheek and Watson (1989) surveyed 180 shy individuals about the types of experiences that are associated with shyness and social anxiety. Eighty-four percent of the participants’ responses to the survey fell into one of three categories: the physical aspects of social anxiety (uncomfortable feelings and sensations), the cognitive aspects of social anxiety (anxious thoughts, expectations, predictions), and the behavioral aspects of social anxiety (for example, avoidance of social situations). 为了定义害羞，Cheek 和 Watson（1989）对 180 名害羞个体进行了调查，了解与害羞和社交焦虑相关的各种体验。参与者中有 84%的回答属于以下三类之一：社交焦虑的身体方面（不适的感觉和感受）、社交焦虑的认知方面（焦虑的想法、期望、预测）以及社交焦虑的行为方面（例如，回避社交场合）。
Cognitive behavioral treatments for social anxiety encourage people to think of their social anxiety in terms of these three components. In other words, when you feel anxious, you should pay attention to what you feel, think, and do. Breaking down your social anxiety into these components will help to make the problem feel less overwhelming and will set the stage for using the strategies outlined in this book. 认知行为治疗针对社交焦虑，鼓励人们将社交焦虑视为这三个组成部分。换句话说，当你感到焦虑时，应关注你所感受到的、所想的以及所做的。将你的社交焦虑分解为这些组成部分，有助于让问题感觉不那么难以应对，并为使用本书中概述的策略奠定基础。
Social Anxiety and Physical Feelings 社交焦虑与身体感觉
Anxiety in social situations is often associated with a long list of physical arousal symptoms, and some of these feelings may themselves be sources of fear and anxiety. For example, people with elevated social anxiety are often especially fearful of symptoms that may be noticeable to other people, such as shaky hands, sweating, blushing, and a trembling voice. Examples of feelings that you may experience in social situations include: 社交场合中的焦虑通常伴随着一长串身体激动症状，其中一些感觉本身可能成为恐惧和焦虑的来源。例如，社交焦虑较高的人通常特别害怕那些可能被他人注意到的症状，如手抖、出汗、脸红和声音颤抖。你在社交场合可能体验到的感觉示例包括：
Racing or pounding heart 心跳加速或剧烈跳动
Breathlessness or smothering feelings 呼吸急促或窒息感
Dizziness or lightheadedness 头晕或头昏眼花
Difficulty swallowing, choking feelings, or a “lump” in the throat 吞咽困难、窒息感或喉咙有“异物感”
Quivering or shakiness (for example, in the hands, knees, lips, or whole body) 颤抖或发抖（例如，手、膝盖、嘴唇或全身）
Blushing 脸红
Nausea, diarrhea, or “butterflies” in the stomach 恶心、腹泻或胃部“蝴蝶飞舞”的感觉
Excessive sweating 过度出汗
Shaky voice 声音发抖
Tearfulness, crying 易流泪，哭泣
Poor concentration or forgetting what you were trying to say 注意力不集中或忘记你想说的话
Blurred vision 视力模糊
Numbness and tingling sensations 麻木和刺痛感
Feelings of unreality or being detached 感觉不真实或与现实脱节
Tightness or weakness in the muscles (for example, wobbly legs, sore neck) 肌肉紧绷或无力（例如，腿软、脖子酸痛）
Chest pain or tightness in chest muscles 胸痛或胸部肌肉紧绷
Dry mouth 口干
Hot flushes or chills 潮热或寒战
People who are socially anxious differ from one another with respect to the ways in which they experience these feelings when they are anxious. Some people report many different physical symptoms. Others report only a few of these feelings. In fact, some people are not aware of any physical sensations when they are anxious. 社交焦虑者在感受到焦虑时体验这些感觉的方式各不相同。有些人报告有许多不同的身体症状，另一些人则只报告少数几种感觉。事实上，有些人在焦虑时甚至没有察觉到任何身体感觉。
There is also evidence that people are often unable to accurately report the intensity of these sensations. People who are socially anxious often report that their physical symptoms are very intense, particularly those symptoms that might be visible to other people. This is, however, often not the case. For the majority of people who are socially anxious, their symptoms are much less noticeable than they think. For example, a study by Mulkens, de Jong, Dobbelaar, and Bögels (1999) found that when socially anxious individuals are exposed to a stressful social situation, they are more likely than nonanxious individuals to believe that they are blushing. However, the study also found 还有证据表明，人们往往无法准确报告这些感觉的强度。社交焦虑者常常报告他们的身体症状非常强烈，尤其是那些可能被他人看到的症状。然而，情况往往并非如此。对于大多数社交焦虑者来说，他们的症状远没有他们想象的那么明显。例如，Mulkens、de Jong、Dobbelaar 和 Bögels（1999 年）的一项研究发现，当社交焦虑者暴露于压力社交情境时，他们比非焦虑者更可能认为自己在脸红。然而，该研究还发现
that there were no differences between socially anxious and nonanxious people with respect to the actual intensity of blushing. 在脸红的实际强度方面，社交焦虑者和非焦虑者之间没有差异。
Although in most cases people’s anxiety symptoms are less noticeable than they think, there is no question that a small number of individuals have a tendency to blush, shake, or sweat that is clearly excessive and may actually be quite noticeable to other people. In other words, some people blush easily and others don’t. Some people have shakier hands than others, and some people perspire more than others. However, not everyone who blushes, sweats, and shakes excessively also experiences intense fear when around other people. In fact, many people are not terribly concerned about experiencing these symptoms in front of other people. 尽管在大多数情况下，人们的焦虑症状没有他们想象的那么明显，但毫无疑问，有少数人有明显过度的脸红、颤抖或出汗倾向，这些症状实际上可能相当引人注意。换句话说，有些人容易脸红，有些人则不容易；有些人手比别人更颤抖，有些人出汗比别人更多。然而，并非所有脸红、出汗和颤抖过度的人在与他人相处时都会感到强烈的恐惧。事实上，许多人并不太在意在他人面前出现这些症状。
In other words, experiencing these symptoms is not the problem. Rather, it is your beliefs about the meaning and possible consequences of these symptoms that contributes to your social anxiety. If you didn’t care whether other people noticed your physical anxiety symptoms you would probably be much less anxious in social and performance situations. Furthermore, you would probably experience fewer of these uncomfortable symptoms. 换句话说，经历这些症状本身并不是问题。真正的问题在于你对这些症状的意义及其可能后果的信念，这些信念加剧了你的社交焦虑。如果你不在意别人是否注意到你的身体焦虑症状，你在社交和表现场合中可能会少很多焦虑感。此外，你可能也会经历更少的不适症状。
Not surprisingly, the physical sensations that you experience when you are anxious or fearful are similar to those that you experience during any intense emotion, including excitement and anger. The differences between fear, excitement, and anger manifest not so much in the way they feel physically, but rather in the types of thoughts and behaviors associated with each of these emotions. It is to these aspects of social anxiety that we now turn our attention. 不足为奇的是，当你感到焦虑或害怕时所体验到的身体感觉，与任何强烈情绪时的感觉相似，包括兴奋和愤怒。恐惧、兴奋和愤怒之间的区别并不主要体现在身体感觉上，而更多体现在与这些情绪相关的思维方式和行为类型上。接下来，我们将关注社交焦虑的这些方面。
Social Anxiety and Thinking 社交焦虑与思维
Strictly speaking, people don’t react emotionally to the situations and events in their lives. Rather, they react to their beliefs and interpretations concerning these events and situations. In other words, given an identical situation, different people might have completely different emotional responses, depending on their beliefs about the situation. 严格来说，人们并不是对生活中的情境和事件产生情绪反应。相反，他们是对自己关于这些事件和情境的信念和解释产生反应。换句话说，面对相同的情境，不同的人可能会有完全不同的情绪反应，这取决于他们对该情境的信念。
Consider the following example. Imagine that you have interviewed for a job and are waiting to hear about the outcome of the interview. You were told that you would hear within a week. Two weeks have passed, and you still haven’t heard from anyone about whether you were selected for the position. How would you feel? What emotions would you be experiencing? Well, you might be nervous if you thought the lack of a call was a sign that you didn’t get the job. On the other hand, if you thought no call was a sign that decisions had not yet been made, you might feel more optimistic. You might be angry if you believed that the interviewer was treating you disrespectfully by not calling. 考虑以下例子。假设你参加了一次工作面试，正在等待面试结果。有人告诉你会在一周内得到回复。两周过去了，你仍然没有收到任何关于是否被录用的消息。你会有什么感受？你会经历哪些情绪？如果你认为没有电话是你没得到这份工作的信号，你可能会感到紧张。另一方面，如果你认为没有电话是因为决定尚未做出，你可能会感到更乐观。如果你认为面试官不打电话是在不尊重你，你可能会感到愤怒。
Often our beliefs are accurate; however, sometimes our beliefs are exaggerated or incorrect. For example, some people who are socially anxious are quick to assume that another person doesn’t like them just because he or she seems uninterested during a conversation. In reality, there are many reasons why a person might look uninterested when talking to you. Some of these include: 我们的信念往往是准确的；然而，有时我们的信念被夸大或不正确。例如，一些社交焦虑的人很快就会假设另一个人不喜欢他们，仅仅因为对方在交谈时看起来不感兴趣。实际上，一个人在与你交谈时看起来不感兴趣可能有很多原因。其中一些包括：
The other person is not interested in the topic of the conversation but still likes you as an individual. 对方对谈话的主题不感兴趣，但仍然喜欢你这个人。
The other person is hungry. 对方饿了。
The other person is in a hurry (for example, he or she is late for an appointment). 对方很着急（例如，他或她迟到了一个约会）。
The other person is tired. 对方感到疲倦。
The other person is feeling sick or unwell. 对方感到生病或不舒服。
The other person is shy or socially anxious. 对方害羞或有社交焦虑。
The other person is thinking about something stressful that happened earlier in the day. 对方正在思考当天早些时候发生的某件令人紧张的事情。
The other person is worrying about something that is coming up. 对方正在担心即将发生的事情。
The other person is someone who generally doesn’t enjoy conversations. 对方通常不喜欢交谈。
The other person is someone who always looks somewhat uninterested, even when he or she is having a good time. 对方总是看起来有些不感兴趣，即使他或她正在享受时光。
You are incorrectly assuming that the other person is uninterested even though he or she is showing all the usual signs of interest. 你错误地认为对方不感兴趣，尽管他或她表现出了所有通常的兴趣迹象。
If you are anxious in social situations, the chances are that you are either interpreting the situations as threatening in some way or are predicting that something negative is likely to occur. The more often you experience social or performance anxiety, the more often you probably engage in this style of anxious thinking. We will provide a more detailed discussion of the role of thoughts in social anxiety in chapter 6. For now, here are common beliefs held by people who are socially anxious: 如果你在社交场合感到焦虑，很可能是因为你以某种方式将这些情境解读为威胁，或者预测可能会发生负面的事情。你越频繁地经历社交或表现焦虑，就越可能采用这种焦虑的思维方式。我们将在第 6 章中更详细地讨论思维在社交焦虑中的作用。现在，以下是社交焦虑者常持有的一些信念：
It’s essential that everyone likes me. 每个人都喜欢我，这是至关重要的。
If someone doesn’t like me, it means I am unlikable. 如果有人不喜欢我，那就意味着我不可被喜欢。
If someone rejects me, I deserve it. 如果有人拒绝我，那是我应得的。
People should always be interested in what I am saying. 人们应该总是对我说的话感兴趣。
People should never have a disapproving or bored look on their face when I am talking. 当我说话时，人们脸上绝不应该有不赞成或厌烦的表情。
People should never talk about me behind my back. 人们绝不应该在我背后议论我。
If I make a mistake at work, I’ll get fired. 如果我在工作中犯错，我会被解雇。
People will be angry with me if I make a mistake. 如果我犯错，人们会生我的气。
I’ll make a fool of myself if I give a presentation. 如果我做演讲，我会出丑。
People can tell when I’m nervous. 人们能看出我紧张。
People find me unattractive, boring, stupid, lazy, incompetent, weird, weak, and so on. 人们觉得我没吸引力、无聊、愚蠢、懒惰、无能、古怪、软弱，诸如此类。
People are untrustworthy, judgmental, and nasty. 人们不可信，爱评头论足，而且刻薄。
I should be able to hide my anxiety symptoms. 我应该能够隐藏我的焦虑症状。
It’s awful to blush, shake, or sweat in front of others. 在别人面前脸红、发抖或出汗是很糟糕的。
If my hands shake at work, it will be a disaster. 如果我在工作时手抖，那将是一场灾难。
Anxiety is a sign of weakness. 焦虑是软弱的表现。
I should not appear anxious in front of others. 我不应该在别人面前表现出焦虑。
I won’t be able to speak if I’m too anxious. 如果我太焦虑，我就说不出话来。
Social Anxiety and Behavior 社交焦虑与行为
The most common behavioral response to feeling anxious or frightened is to either avoid the anxiety-provoking situation completely or to do something else to reduce the anxiety as quickly as possible. The reason people engage in these behaviors is because they are very effective at reducing discomfort-in the short term. However, in the long term, these behaviors have the effect of maintaining fear and anxiety in social situations because they prevent people from learning that their anxiety-provoking predictions are unlikely to come true. Following are some examples of behaviors that people often use to reduce their anxiety in social situations. Notice that some of these are examples involving complete escape or avoidance. However, other examples involve partial avoidance, efforts to reduce anxiety, or attempts to protect oneself in the situation. These behaviors are often called safety behaviors, because they are carried out in an effort to feel safer in the feared situation: 对感到焦虑或害怕时最常见的行为反应是要么完全避免引发焦虑的情境，要么做些其他事情以尽快减轻焦虑。人们之所以采取这些行为，是因为它们在短期内非常有效地减少了不适感。然而，从长远来看，这些行为会导致在社交场合中维持恐惧和焦虑，因为它们阻止了人们认识到那些引发焦虑的预测不太可能成真。以下是一些人们常用来减轻社交场合焦虑的行为例子。请注意，其中一些是完全逃避或回避的例子，而其他例子则涉及部分回避、减轻焦虑的努力或试图在情境中保护自己。这些行为通常被称为安全行为，因为它们是在努力让自己在害怕的情境中感到更安全：
Turning down an invitation to a party 拒绝参加聚会的邀请
Making an excuse not to have dinner with a friend 找借口不和朋友共进晚餐
Never answering questions in class 在课堂上从不回答问题
Always arriving late for meetings and leaving early in order to avoid making small talk 总是迟到参加会议，并提前离开以避免闲聊
Offering to help with the dishes at a party in order to avoid talking to the guests 在聚会上主动帮忙洗碗，以避免与客人交谈
Making an excuse to get off the telephone with a friend or coworker 找借口结束与朋友或同事的电话
Distracting yourself from your anxious thoughts 分散注意力，摆脱焦虑的想法
Having the room dark during your presentation in order to keep the audience focused on the slides rather than on you 在演讲时将房间调暗，以便让观众专注于幻灯片而不是你本人
Filling out a check before arriving at a store in order to avoid having to write in front of others 在到达商店之前填写支票，以避免在他人面前书写
Avoiding eye contact and talking very quietly during conversations with others 在与他人交谈时避免眼神接触，并且说话声音很轻
Wearing makeup and a turtleneck sweater to hide your blushing 化妆并穿高领毛衣以掩盖脸红
Always attending the office holiday party with a close friend, spouse, or other safe person, even though other guests usually attend alone 总是和亲密的朋友、配偶或其他安全的人一起参加办公室的节日聚会，尽管其他客人通常是独自参加的
Always arriving for meetings early to ensure that it will not be necessary to enter the room after everyone else is already seated 总是提前到达会议现场，以确保不必在其他人都已入座后才进入房间
Having a couple of glasses of wine before meeting another person for a date 在与他人约会前喝几杯葡萄酒
Interactions Among the Three Components 三者之间的相互作用
The cycle of fear and anxiety can begin with any of the three components we’ve just discussed. For example, you may be talking to a colleague at work when you notice yourself perspiring slightly (physical component). That may lead to anxious thoughts about whether your colleague is noticing your sweaty brow and wondering if there is something wrong with you (cognitive component). As your anxiety increases, the intensity of your physical sensations increases and you continue to think anxious thoughts. Eventually, you may make an excuse to leave the situation (behavioral component). 恐惧和焦虑的循环可以从我们刚才讨论的三个组成部分中的任何一个开始。例如，你可能正在和同事交谈时，注意到自己微微出汗（身体成分）。这可能引发你焦虑地思考同事是否注意到了你额头的汗水，并怀疑自己是否出了什么问题（认知成分）。随着焦虑的加剧，你的身体感觉也变得更加强烈，你继续产生焦虑的想法。最终，你可能会找借口离开这种情境（行为成分）。
Alternatively, the cycle may begin with the cognitive component. For example, before giving a presentation, you may tell yourself that you are going to lose your train of thought and that others will notice how uncomfortable you are. You imagine that the others will interpret your discomfort as a sign of weakness (cognitive component). As you continue to dwell on these anxious thoughts, you notice your face beginning to feel flushed and your heart rate increasing (physical component). Finally, you make a decision to read your presentation word for word to be sure that your anxiety doesn’t cause you to lose your place during the presentation (behavioral component). 或者，这个循环可能从认知成分开始。例如，在做演讲之前，你可能会告诉自己你会忘词，别人会注意到你有多不自在。你想象别人会把你的不适解读为软弱的表现（认知成分）。当你继续沉浸在这些焦虑的想法中时，你会注意到脸开始发红，心跳加快（身体成分）。最后，你决定逐字朗读你的演讲稿，以确保焦虑不会让你在演讲中迷失位置（行为成分）。
Finally, the cycle may start with the behavioral component, namely avoidance and safety behaviors. By putting off getting together with friends for a long time (behavioral component), you are more likely to experience anxious thoughts (cognitive component) about what might happen when you do see them, as well as uncomfortable physical feelings when you are actually in the situation (physical component). Although avoiding anxiety-provoking situations can be comforting in the short term, it also can have the effect of making the situation even more uncomfortable when you finally confront it. The longer you put off an unpleasant task, the harder it is to start the task when you finally decide to do it. 最后，这个循环可能从行为成分开始，即回避和安全行为。通过长时间推迟与朋友见面（行为成分），你更有可能产生关于见面时可能发生的事情的焦虑想法（认知成分），以及在实际处于这种情境时感受到的不适身体感觉（身体成分）。虽然回避引发焦虑的情境在短期内可能带来安慰，但当你最终面对它时，这种回避也可能使情境变得更加不舒服。你拖延一项令人不快的任务的时间越长，当你最终决定去做时，开始这项任务就越困难。
Exercise: Components of Social Anxiety 练习：社交焦虑的成分
Over the next week or so, photocopy and use the Three Components of Social Anxiety Monitoring Form (found at the end of this chapter) to record your anxiety in terms of the three components of fear. Try to complete the form each time you encounter a feared social situation (if possible, at least three times in the next week). In the first column, record the situation (including time and place). In the second column, record the intensity of your fear using a scale from 0 (no fear) to 100 (maximum fear). In the third column, record the physical sensations that you experienced in the situation. In the fourth column, record any anxiety-provoking thoughts or predictions that you are aware of regarding the situation. Finally, in the fifth column, record any avoidance behaviors or any other anxious behaviors used to reduce your anxiety. In addition to the blank form, a sample completed form is included. 在接下来的一周左右时间里，复印并使用本章末尾的社交焦虑三要素监测表，记录你在恐惧的三个要素方面的焦虑情况。尽量在每次遇到恐惧的社交情境时填写该表格（如果可能，至少在接下来的一周内填写三次）。在第一栏，记录情境（包括时间和地点）。在第二栏，使用 0（无恐惧）到 100（极度恐惧）的量表记录你的恐惧强度。第三栏，记录你在该情境中体验到的身体感觉。第四栏，记录你意识到的任何引发焦虑的想法或对该情境的预测。最后，在第五栏，记录任何回避行为或为减轻焦虑而采取的其他焦虑行为。除了空白表格外，还附有一个填写示例表格。
OTHER PROBLEMS AND FEATURES 其他问题和特征
Social anxiety is often associated with other problems. These may include panic attacks in social situations, excessively high standards and perfectionism, depressed mood, a negative body image, substance abuse, or difficulty trusting others. We will now discuss each of these associated difficulties. 社交焦虑常常伴随着其他问题。这些问题可能包括社交场合中的恐慌发作、过高的标准和完美主义、抑郁情绪、负面的身体形象、物质滥用或难以信任他人。我们现在将讨论这些相关的困难。
Panic Attacks 恐慌发作
If you experience intense social anxiety, the chances are good that you have had panic attacks in social and performance situations. As discussed at the beginning of this chapter, a panic attack is a rush of fear that occurs in the absence of any realistic danger. According to the definition of a panic attack, the fear must peak within ten 如果你经历过强烈的社交焦虑，很可能在社交和表演场合中出现过恐慌发作。正如本章开头所讨论的，恐慌发作是一种在没有任何现实危险的情况下突然出现的恐惧感。根据恐慌发作的定义，恐惧感必须在十分钟内达到顶峰，
minutes, although it usually peaks immediately or within a few seconds. Also, to meet the full criteria for a panic attack, there must be at least four symptoms from a list of thirteen, including racing heart, chest discomfort, dizziness, breathlessness, shaking, stomach discomfort, sweating, choking feelings, hot flashes or chills, feelings of unreality or detachment, numbness or tingling, and fears of dying, going crazy, or losing control. 分钟，尽管通常在几秒钟内或立即达到高峰。此外，要满足恐慌发作的完整标准，必须从十三种症状中至少出现四种，包括心跳加速、胸部不适、头晕、呼吸急促、颤抖、胃部不适、出汗、窒息感、潮热或寒战、现实感丧失或分离感、麻木或刺痛感，以及害怕死亡、发疯或失控的恐惧。
For those who suffer from social anxiety, panic attacks tend to be triggered by exposure to feared social situations or even just thinking about being in a feared situation. In addition, people who are socially anxious are often fearful of experiencing panic symptoms. Because panic-attack symptoms are often incorrectly viewed as a sign that one is about to lose control, it’s no wonder that people who are socially anxious would want to avoid having panic attacks in front of others. Even though people who experience panic attacks often are afraid of losing control, going crazy, fainting, having a heart attack, or experiencing some other physical or social catastrophe, such consequences are extremely unlikely. In other words, panic attacks are uncomfortable, but they aren’t dangerous. In fact, the symptoms often are not even noticeable to other people. 对于那些患有社交焦虑的人来说，恐慌发作往往是由暴露于害怕的社交场合或甚至仅仅是想到处于害怕的情境中所引发的。此外，社交焦虑者通常害怕经历恐慌症状。由于恐慌发作的症状常被错误地视为即将失控的信号，难怪社交焦虑者会想要避免在他人面前发生恐慌发作。尽管经历恐慌发作的人常常害怕失控、发疯、晕倒、心脏病发作或遭遇其他身体或社交灾难，但这些后果极不可能发生。换句话说，恐慌发作虽然令人不适，但并不危险。事实上，这些症状往往甚至不被他人察觉。
Perfectionism 完美主义
Research from our organization (Antony et al. 1998) and elsewhere has found that social anxiety is associated with elevated levels of perfectionism. Perfectionists hold standards that are unrealistically high and overly rigid. They may have exaggerated concerns about making mistakes and often go out of their way to ensure that mistakes are avoided. 我们组织（Antony 等人，1998 年）及其他机构的研究发现，社交焦虑与完美主义水平升高有关。完美主义者设定的标准不切实际且过于僵化。他们可能对犯错有夸大的担忧，常常不遗余力地确保避免错误发生。
In social anxiety, people tend to place too much importance on making a perfect impression on others. If they are not guaranteed to be approved of by others, they may feel very anxious in social situations or avoid socializing altogether. Perfectionism is different from simply having high standards. High standards are often useful because they motivate us to work hard and succeed. In the case of perfectionism, however, the standards are so high and so inflexible that they actually interfere with performance by causing a person to overprepare for tasks (for instance, spending hours rehearsing a presentation), procrastinate (such as putting off preparing for a presentation), or be overly critical of his or her own performance. 在社交焦虑中，人们往往过分重视给他人留下完美的印象。如果不能保证获得他人的认可，他们可能在社交场合感到非常焦虑，甚至完全避免社交。完美主义不同于单纯的高标准。高标准通常是有益的，因为它们激励我们努力工作并取得成功。然而，在完美主义的情况下，标准过高且过于僵化，实际上会妨碍表现，使人过度准备任务（例如，花费数小时排练演讲）、拖延（如推迟准备演讲）或对自己的表现过于苛刻。
Depression 抑郁症
Given the impact of social anxiety on a person’s functioning, it is no wonder that a substantial number of people with social anxiety disorder also experience depression. Severe social anxiety can lead to isolation, loneliness, and deep sadness. Social anxiety disorder can prevent a person from living up to his or her potential, which, in turn, can lead to feelings of hopelessness and depression. Depression can also increase the severity of social anxiety. 鉴于社交焦虑对一个人功能的影响，难怪大量患有社交焦虑障碍的人也会经历抑郁。严重的社交焦虑可能导致孤立、孤独和深深的悲伤。社交焦虑障碍可能阻碍一个人发挥其潜力，进而导致无望感和抑郁。抑郁也可能加重社交焦虑的严重程度。
People who are depressed are often embarrassed about feeling down, may assume that others don’t want to be around them, and may avoid being around other people. Social anxiety and depression are associated with similar thought patterns as wellspecifically, negative thoughts about oneself and about one’s relationships. Finally, there is reason to think that social anxiety disorder and depression may be related to similar biological processes in the brain. In fact, the treatments discussed in this book (including both psychological treatments and medications) have been shown to be useful for both anxiety and depression. 抑郁的人常常为自己的情绪低落感到尴尬，可能会认为别人不想和自己在一起，并可能避免与他人接触。社交焦虑和抑郁都与类似的思维模式有关，特别是对自己和自己人际关系的负面看法。最后，有理由认为社交焦虑障碍和抑郁可能与大脑中类似的生物过程有关。事实上，本书讨论的治疗方法（包括心理治疗和药物治疗）已被证明对焦虑和抑郁均有效。
Body Image Problems 身体形象问题
People who are unhappy with their physical appearance may feel anxious when socializing or being watched by others. For example, people with eating disorders such as anorexia nervosa and bulimia nervosa may avoid activities that involve eating in front of others or showing their bodies (such as wearing shorts, swimming, or exercising in public). People who are overweight may also be concerned about having their physical appearance judged negatively by others. In fact, dissatisfaction with any aspect of one’s physical appearance (for example, losing your hair, not liking your nose, and so on) can lead some people to experience social anxiety. 对自己外貌不满意的人在社交或被他人注视时可能会感到焦虑。例如，患有神经性厌食症和神经性贪食症等饮食失调的人可能会避免在他人面前进食或展示身体（如穿短裤、游泳或在公共场合锻炼）。超重的人也可能担心他人对其外貌作出负面评价。事实上，对身体任何方面的不满（例如脱发、不喜欢自己的鼻子等）都可能导致一些人产生社交焦虑。
Substance Abuse 物质滥用
Some people who experience excessive levels of social anxiety use alcohol or other drugs to help cope with social situations. In most cases, this may involve only having an extra glass of wine at a party or having a beer when eating out with friends. However, for some people, using alcohol or drugs to manage anxiety can become a problem if the drug or alcohol use becomes excessive. If you frequently use excessive amounts of alcohol or other drugs to feel more comfortable in social situations, it may be important to address this issue at the same time that you are working on your social anxiety. 有些经历过度社交焦虑的人会使用酒精或其他药物来帮助应对社交场合。在大多数情况下，这可能只是指在聚会上多喝一杯葡萄酒，或与朋友外出吃饭时喝一瓶啤酒。然而，对于某些人来说，如果使用酒精或药物来管理焦虑变得过度，这可能会成为一个问题。如果你经常大量使用酒精或其他药物来让自己在社交场合感到更舒适，那么在你处理社交焦虑的同时，解决这个问题可能也很重要。
Anger and Mistrust of Others 愤怒与对他人的不信任
In addition to fearing negative judgment from others, some people with high levels of social anxiety may also have difficulty trusting others. They may avoid confiding in others, not only for fear of being judged, but also because they’re afraid that other people will not be able to keep a secret. Social anxiety is also sometimes associated with elevated levels of anger and irritability. For example, some people with social anxiety disorder may become very angry or hostile when being looked at by others. They may also become angry at perceived rejections by other people. 除了害怕他人的负面评价外，一些高度社交焦虑的人可能还难以信任他人。他们可能避免向他人倾诉，不仅是因为害怕被评判，还因为担心别人无法保守秘密。社交焦虑有时还与较高的愤怒和易怒水平有关。例如，一些社交焦虑障碍患者在被他人注视时可能会变得非常愤怒或敌对。他们也可能因感知到他人的拒绝而生气。
OVERCOMING SOCIAL ANXIETY 克服社交焦虑
Two general approaches have been shown to be useful for overcoming social anxiety: psychological strategies and medications. We’ll discuss each of these briefly. 两种通用方法已被证明对克服社交焦虑有效：心理策略和药物治疗。我们将简要讨论这两种方法。
Psychological Strategies 心理策略
Although there are many different types of psychotherapy practiced by mental health professionals, there are only a small number of strategies that have been shown to be effective for reducing social anxiety in a relatively brief amount of time. The chapters in this book discuss three general approaches that repeatedly have been shown to be effective for treating social anxiety disorder: 虽然心理健康专业人员采用了许多不同类型的心理治疗，但只有少数几种策略被证明能在相对较短的时间内有效减少社交焦虑。本书的章节讨论了三种反复被证明对治疗社交焦虑症有效的总体方法：
Exposure-based strategies will teach you to approach feared situations gradually, over and over again, until they no longer provoke fear. 基于暴露的策略将教你逐步接近令你害怕的情境，一遍又一遍，直到它们不再引发恐惧。
Cognitive strategies will be used to help you to identify your anxiety-provoking thoughts and to replace them with more realistic ways of thinking. 认知策略将帮助你识别引发焦虑的想法，并用更现实的思维方式取代它们。
Instruction in basic communication skills will teach you to communicate more assertively, meet people more easily, give effective presentations, and use nonverbal communication appropriately. 基本沟通技巧的指导将教你更自信地交流，更容易结识他人，有效地进行演讲，并恰当地使用非语言交流。
Medications 药物治疗
There are a number of medications that have been shown to be effective for decreasing social anxiety. These include a range of antidepressants as well as certain tranquilizers. As long as the person continues to take the medication, these treatments are about as effective as the psychological strategies discussed in this book. For some people, the combination of medication and psychological treatment is the most effective approach. In chapter 5 we will discuss the benefits and costs of using particular medications for treating your social anxiety. 已有多种药物被证明对减轻社交焦虑有效。这些药物包括多种抗抑郁药以及某些镇静剂。只要患者持续服用这些药物，这些治疗方法的效果大致与本书中讨论的心理策略相当。对于某些人来说，药物治疗与心理治疗相结合是最有效的方法。在第 5 章中，我们将讨论使用特定药物治疗社交焦虑的利弊。
The Shyness & Social Anxiety Workbook 害羞与社交焦虑工作手册
Three Components of Social Anxiety Monitoring Form-Completed Sample 社交焦虑监测表的三个组成部分-填写示例
Place/Situation/Time 地点/情境/时间
Fear (0-100) 恐惧（0-100）
Physical Feelings 身体感觉
Anxiety-Provoking Thoughts 引发焦虑的想法
Anxious Behaviors 焦虑行为
At a party on Tuesday night; I said to Mike, "It's been ages since I saw you last," and be responded by reminding me that I just saw him last week! 星期二晚上在一个聚会上；我对迈克说：“好久不见了，”他却提醒我上周才见过他！
90
Heart racing, sweating, shaking, short of breath 心跳加速，出汗，发抖，呼吸急促
I can't believe I said that! Mike must think I'm an idiot for forgetting that I just saw bim. Maybe be thinks I don't care enough to remember bim. He must notice that I am a nervous wreck! 我真不敢相信我说了那样的话！迈克一定觉得我很笨，居然忘了刚见过他。也许他觉得我不够在乎，才会记不住他。他一定注意到我紧张得要命！
Apologized to Mike about 5 times, and then went to the bathroom to get away from bim. After about 10 minutes, I made an excuse and left the party. 向迈克道歉了大约五次，然后去了洗手间躲开他。大约十分钟后，我找了个借口离开了聚会。
Wednesday evening. Preparing for a brief presentation on Friday. 星期三晚上。准备周五的简短演讲。
70
Heart racing, muscle tightness 心跳加速，肌肉紧绷
I will lose my train of thought. People will think I am incompetent. I will lose my job if I blow this presentation. 我会忘记自己要说的话。人们会认为我无能。如果这次演讲失败，我会失去工作。
Had two glasses of wine to calm down. Rebearsed my presentation about 20 times. Asked a coworker to present with me. 喝了两杯酒来平静自己。演练了大约 20 次演讲。请同事和我一起做演讲。
Saturday afternoon. Walking through the mall. 星期六下午。走在商场里。
50
Feeling flushed, palms are sweaty, heart is racing 感到脸红，手心出汗，心跳加速
People are staring at me. They can tell I'm anxious. They are probably thinking I look funny or that I walk funny. 人们都在盯着我看。他们能看出我很紧张。他们可能在想我看起来很滑稽，或者我走路的样子很奇怪。
I avoided eye contact with other people. After about 5 minutes, left the mall, even though I badn't finished my shopping! 我避免与别人眼神交流。大约五分钟后，我离开了商场，尽管我还没买完东西！
Place/Situation/Time Fear (0-100) Physical Feelings Anxiety-Provoking Thoughts Anxious Behaviors
At a party on Tuesday night; I said to Mike, "It's been ages since I saw you last," and be responded by reminding me that I just saw him last week! 90 Heart racing, sweating, shaking, short of breath I can't believe I said that! Mike must think I'm an idiot for forgetting that I just saw bim. Maybe be thinks I don't care enough to remember bim. He must notice that I am a nervous wreck! Apologized to Mike about 5 times, and then went to the bathroom to get away from bim. After about 10 minutes, I made an excuse and left the party.
Wednesday evening. Preparing for a brief presentation on Friday. 70 Heart racing, muscle tightness I will lose my train of thought. People will think I am incompetent. I will lose my job if I blow this presentation. Had two glasses of wine to calm down. Rebearsed my presentation about 20 times. Asked a coworker to present with me.
Saturday afternoon. Walking through the mall. 50 Feeling flushed, palms are sweaty, heart is racing People are staring at me. They can tell I'm anxious. They are probably thinking I look funny or that I walk funny. I avoided eye contact with other people. After about 5 minutes, left the mall, even though I badn't finished my shopping!| Place/Situation/Time | Fear (0-100) | Physical Feelings | Anxiety-Provoking Thoughts | Anxious Behaviors |
| :--- | :--- | :--- | :--- | :--- |
| At a party on Tuesday night; I said to Mike, "It's been ages since I saw you last," and be responded by reminding me that I just saw him last week! | 90 | Heart racing, sweating, shaking, short of breath | I can't believe I said that! Mike must think I'm an idiot for forgetting that I just saw bim. Maybe be thinks I don't care enough to remember bim. He must notice that I am a nervous wreck! | Apologized to Mike about 5 times, and then went to the bathroom to get away from bim. After about 10 minutes, I made an excuse and left the party. |
| Wednesday evening. Preparing for a brief presentation on Friday. | 70 | Heart racing, muscle tightness | I will lose my train of thought. People will think I am incompetent. I will lose my job if I blow this presentation. | Had two glasses of wine to calm down. Rebearsed my presentation about 20 times. Asked a coworker to present with me. |
| Saturday afternoon. Walking through the mall. | 50 | Feeling flushed, palms are sweaty, heart is racing | People are staring at me. They can tell I'm anxious. They are probably thinking I look funny or that I walk funny. | I avoided eye contact with other people. After about 5 minutes, left the mall, even though I badn't finished my shopping! |
CHAPTER 2 第二章
Why Do You Have These Fears? 你为什么会有这些恐惧？
BIOLOGICAL FACTORS 生物因素
As with any emotion or personality trait, our biology affects the tendency to experience anxiety in social situations (Mathew and Ho 2006). Biological processes such as natural selection or evolution, genetics, brain activity, and alterations in the levels of certain neurotransmitters in the brain may all contribute to social anxiety. We’ll discuss each of these in this section. 和任何情绪或人格特质一样，我们的生物学影响着在社交场合中体验焦虑的倾向（Mathew 和 Ho 2006）。生物过程如自然选择或进化、遗传学、大脑活动以及大脑中某些神经递质水平的变化，都可能促成社交焦虑。本节将讨论这些内容。
Natural Selection: The Evolutionary Function of Social Anxiety 自然选择：社交焦虑的进化功能
Natural selection is the process by which members of a species who are best able to adapt to their environments are the most likely to reproduce successfully, thereby causing the species to evolve gradually and to survive over a long period of time. It makes sense that through natural selection, those among us who are most fit and healthy might be more likely to survive and to reproduce than those who are less so. However, several authors have argued that many of the illnesses from which humans suffer may also 自然选择是指一个物种中最能适应环境的成员最有可能成功繁殖，从而使该物种逐渐进化并长期存活的过程。通过自然选择，那些最健康、最适应环境的人更有可能生存和繁殖，这一点是合理的。然而，有几位作者认为，人类所患的许多疾病也可能
have developed according to the same laws of natural selection that are thought to have guided the more “positive” aspects of human evolution (Moalem and Prince 2007; Nesse and Williams 1994). 根据被认为指导人类进化中更“积极”方面的自然选择法则，这些也按照相同的规律发展而来（Moalem 和 Prince 2007；Nesse 和 Williams 1994）。
For example, in their book, Why We Get Sick: The New Science of Darwinian Medicine, Drs. Randolph Nesse and George Williams discuss how a number of uncomfortable conditions such as sneezing from allergies, suffering from colds or fevers, and experiencing pain from injuries all serve to protect us from potential dangers. The same processes that lead to allergies, colds, and fever also help the body to rid itself of potentially dangerous toxins and parasitic viruses. Likewise, pain following an injury is a warning sign that prevents us from moving our bodies in ways that could worsen the injury. 例如，在他们的著作《我们为何生病：达尔文医学新科学》中，Randolph Nesse 博士和 George Williams 博士讨论了许多不适症状，如因过敏打喷嚏、感冒或发烧以及受伤时的疼痛，都是为了保护我们免受潜在危险。导致过敏、感冒和发烧的同样过程，也帮助身体排除潜在的有害毒素和寄生病毒。同样，受伤后的疼痛是一种警告信号，防止我们以可能加重伤势的方式移动身体。
Might anxiety also improve our chances of survival? As we mentioned in chapter 1, the fight-or-flight response associated with fear and panic protects us from potential danger. When we are afraid, our bodies quickly become mobilized either to meet the danger head on or to escape from the danger as quickly as possible. All of the sensations that we experience when we are frightened (for instance, increased pulse, faster breathing, sweating, hyperventilation, and so on) are designed to help us meet the physical demands of confronting the threat (fighting) or escaping to safety (flight). 焦虑是否也能提高我们的生存几率？正如我们在第一章提到的，与恐惧和惊慌相关的战斗或逃跑反应保护我们免受潜在危险。当我们害怕时，身体会迅速动员起来，要么正面迎战危险，要么尽快逃离危险。我们在害怕时体验到的所有感觉（例如，心跳加快、呼吸加速、出汗、过度换气等）都是为了帮助我们应对威胁所需的身体需求（战斗）或逃向安全（逃跑）。
From an evolutionary perspective, it makes sense that we humans would develop a propensity for experiencing social anxiety. We are social beings, and as such, we are very much dependent on those around us. None of us could survive without the help of others. As infants and children, we are completely dependent on our parents for food, shelter, comfort, and education. As we grow up, we continue to depend on other people. We depend on our employers to provide us with money for food and shelter. We depend on other people to build our homes, grow our food, heal our injuries, entertain us, and to help us meet most of our day-to-day needs. Because of our dependence on one another, we learn at a very young age that it is important to get along well with people. Essentially, we want other people to like us. After all, consistently making a bad impression on other people might lead to isolation, unemployment, and many other negative consequences. 从进化的角度来看，人类发展出体验社交焦虑的倾向是有道理的。我们是社会性动物，因此非常依赖周围的人。没有他人的帮助，我们谁都无法生存。作为婴儿和儿童，我们完全依赖父母提供食物、住所、安慰和教育。随着成长，我们继续依赖他人。我们依赖雇主提供食物和住所所需的金钱。我们依赖他人建造房屋、种植食物、治疗伤病、娱乐我们，并帮助我们满足大多数日常需求。正因为彼此依赖，我们很小的时候就学会了与人相处的重要性。归根结底，我们希望别人喜欢我们。毕竟，持续给别人留下不好的印象可能导致孤立、失业以及许多其他负面后果。
Feeling anxious in social situations serves to remind each of us to pay attention to the effects our behavior has on those around us. If we didn’t think about the impact of our behavior on others, we would probably get into trouble more often than not. We wouldn’t bother dressing nicely or being polite. We might always say exactly what’s on our mind without considering whether it might be hurtful. Feeling anxious in social situations protects us from offending other people and from doing things that might lead others to judge us in negative ways. So, not only is it normal to feel shy or socially anxious from time to time, it is also helpful. 在社交场合感到焦虑，是提醒我们关注自己行为对周围人的影响。如果我们不考虑自己行为对他人的影响，可能经常会惹上麻烦。我们也许就不会费心打扮或礼貌待人，可能总是直言不讳，而不考虑是否会伤害别人。在社交场合感到焦虑，可以保护我们不冒犯他人，也避免做出可能导致别人对我们产生负面评价的事情。因此，时不时感到害羞或社交焦虑不仅正常，而且是有益的。
Of course, social anxiety and shyness are not always helpful. Extreme social anxiety may lead to impaired concentration, which, in turn, can cause a person to make more errors at work or school. In addition, socially anxious people often avoid taking social risks and may therefore find it difficult to make friends or to find work. Whereas mild to moderate levels of social anxiety are completely normal and potentially helpful, extreme social anxiety can interfere with a person’s functioning. 当然，社交焦虑和害羞并不总是有益的。极端的社交焦虑可能导致注意力受损，进而使人在工作或学习中犯更多错误。此外，社交焦虑者往往避免冒社交风险，因此可能难以交朋友或找到工作。虽然轻度到中度的社交焦虑完全正常且可能有帮助，但极端的社交焦虑会干扰一个人的正常功能。
So, from an evolutionary perspective, people with social anxiety disorder do not have an illness, per se. Rather, they have too much of a good thing. Social anxiety is helpful in small doses, but when it is too intense, it can make life more difficult. 所以，从进化的角度来看，社交焦虑症患者并不算是一种疾病。相反，他们只是拥有过多的“好东西”。适量的社交焦虑是有益的，但当它过于强烈时，会让生活变得更加困难。
Genetics and Social Anxiety 遗传与社交焦虑
Social anxiety disorder appears to run in families. For example, a study by Stein, Chartier, Hazen, Kozak, et al. (1998) found that having a close relative (for example, a parent, sibling, or child) with generalized social anxiety disorder (extreme anxiety in most social situations) made an individual ten times as likely to have social anxiety disorder, compared with individuals who didn’t have a socially anxious relative. In contrast, more narrowly focused social fears (for example, a fear of public speaking only) were less likely to run in families. 社交焦虑症似乎有家族遗传的倾向。例如，Stein、Chartier、Hazen、Kozak 等人（1998 年）的一项研究发现，拥有一位患有广泛性社交焦虑症（在大多数社交场合极度焦虑）的近亲（例如父母、兄弟姐妹或子女）的人，其患社交焦虑症的可能性是没有社交焦虑亲属者的十倍。相比之下，更狭窄的社交恐惧（例如仅害怕公开演讲）则较少表现出家族遗传的倾向。
Of course, the existence of social anxiety disorder in multiple family members does not necessarily mean that the social anxiety is transmitted by genes. Environmental factors (for example, learning from one’s parents and siblings) can also contribute to the family members sharing certain behaviors and tendencies. To tease out the effects of genetic influences from the effects of environment and learning, scientists have relied on three main types of studies: 当然，多个家庭成员中存在社交焦虑症并不一定意味着社交焦虑是通过基因传递的。环境因素（例如，从父母和兄弟姐妹那里学习）也可能导致家庭成员共享某些行为和倾向。为了区分遗传影响与环境和学习影响的作用，科学家们依赖于三种主要类型的研究：
Twin studies. Twin studies examine the frequency of a problem across pairs of identical twins (twins who are 100 percent genetically identical) vs. pairs of fraternal twins (twins who share, on average, 50 percent of their genetic material). Because twin pairs tend to be raised in similar environments regardless of whether they are identical twins or fraternal twins, a higher social anxiety concordance rate in identical twins than in fraternal twins is thought to be evidence that genetics may have played a larger role in the development of the social anxiety (the term concordance rate refers to the probability of one person having a particular problem if his or her twin also has the problem). 双胞胎研究。双胞胎研究考察同卵双胞胎（基因完全相同的双胞胎）与异卵双胞胎（平均共享 50%基因的双胞胎）中问题的发生频率。由于无论是同卵双胞胎还是异卵双胞胎，双胞胎对通常都在相似的环境中成长，因此如果同卵双胞胎中社交焦虑的一致率高于异卵双胞胎，这被认为是遗传因素在社交焦虑发展中起较大作用的证据（术语“一致率”指的是如果一个双胞胎有某个问题，其另一半也有该问题的概率）。
Adoption studies. In adoption studies, scientists interview both the biological parents and the adoptive parents of people who were adopted as children and who also have the particular problem being studied. If the researcher finds that social anxiety disorder occurs much more frequently in the biological parents of the socially anxious adoptees than in the adoptive parents, it suggests that genetics may be more important than environment. Although adoption studies have been used to study the role of genetics in various disorders and illnesses, this approach has not yet been used in research on social anxiety disorder. 收养研究。在收养研究中，科学家会采访那些在儿童时期被收养且患有特定问题的人们的生物学父母和养父母。如果研究者发现社交焦虑障碍在这些社交焦虑收养者的生物学父母中发生的频率远高于养父母，这表明遗传因素可能比环境因素更为重要。尽管收养研究已被用于研究遗传在各种疾病和病症中的作用，但这种方法尚未被用于社交焦虑障碍的研究。
Molecular genetics studies. In 2003, scientists completed the Human Genome Project, which involved mapping all of the genes in human DNA and determining the sequences of the 3 billion chemical base pairs that 分子遗传学研究。2003 年，科学家完成了人类基因组计划，该计划涉及绘制人类 DNA 中所有基因的图谱，并确定构成人类 DNA 的 30 亿个化学碱基对的序列。
make up human DNA. This work has made it possible for scientists to study particular genes that may be involved in the development of social anxiety disorder and many other conditions, using research methods known as linkage studies and association studies. 这项工作使科学家能够使用称为连锁研究和关联研究的研究方法，研究可能参与社交焦虑障碍及许多其他疾病发展的特定基因。
So, what do we know about the role of genetics in social anxiety disorder? Most of the studies to date on genetics and social anxiety disorder have been twin studies (for instance, Kendler, Karkowski, and Prescott 1999; Kendler et al. 2001; Stein, Jang, and Livesley 2002), and there has also been a small number of molecular genetics studies (for example, Lochner et al. 2007). Generally, twin studies have found modest to moderate levels of heritability for social anxiety disorder, suggesting that although genetics plays a role, other factors such as a person’s environment and experiences are also very important. Molecular genetics studies are just beginning in the area of social anxiety, and over time they should help to uncover which genes are most important in the development of this problem. 那么，我们对遗传在社交焦虑症中的作用了解多少呢？迄今为止，大多数关于遗传与社交焦虑症的研究都是双胞胎研究（例如，Kendler、Karkowski 和 Prescott 1999；Kendler 等人 2001；Stein、Jang 和 Livesley 2002），也有少量分子遗传学研究（例如，Lochner 等人 2007）。总体而言，双胞胎研究发现社交焦虑症具有适度到中等程度的遗传性，这表明虽然遗传起作用，但个人的环境和经历等其他因素也非常重要。分子遗传学研究在社交焦虑领域刚刚起步，随着时间推移，这些研究应能帮助揭示哪些基因在该问题的发展中最为关键。
Two personality traits closely related to social anxiety appear to be heritable as well, with beritability estimates (the extent to which the transmission of a trait across generations is due to genetics) being close to 50 percent across a wide range of studies (Plomin 1989). One of these traits, called neuroticism, is a general tendency to feel distressed, anxious, nervous, and worried. The other trait, called introversion, is a tendency to be inwardly focused and socially withdrawn. Not surprisingly, shyness and social anxiety tend to be associated with both of these personality styles (Briggs 1988). Recently, researchers have started to use molecular genetics studies to identify specific genes that may contribute to traits such as introversion (Stein, Schork, and Gelernter 2004). 与社交焦虑密切相关的两种人格特质似乎也具有遗传性，多项研究显示其遗传率估计值（即跨代传递特质中遗传因素所占的比例）接近 50%（Plomin 1989）。其中一种特质称为神经质，是指一种普遍的倾向，表现为感到痛苦、焦虑、紧张和担忧。另一种特质称为内向，是指一种内心专注且社交回避的倾向。不出意外，害羞和社交焦虑往往与这两种人格风格相关联（Briggs 1988）。最近，研究人员开始利用分子遗传学研究来识别可能影响内向等特质的特定基因（Stein, Schork, 和 Gelernter 2004）。
If genetics does play a role in causing social anxiety, does that mean that social anxiety cannot be changed? Not at all. Our genetic makeup affects just about every aspect of who we are, including physical fitness, academic ability, depression, weight, personality, and even our interests and hobbies. Yet we all know that our behavior and experiences still play an important role in determining our behavior and performance in these various domains. 如果遗传确实在导致社交焦虑中起作用，那是否意味着社交焦虑无法改变？绝对不是。我们的基因构成几乎影响着我们是谁的各个方面，包括身体健康、学业能力、抑郁、体重、性格，甚至我们的兴趣和爱好。然而，我们都知道，我们的行为和经历仍然在决定我们在这些不同领域的行为和表现中起着重要作用。
For example, regardless of whether you are genetically predisposed to be athletic, training hard will improve your athletic ability. Furthermore, the environment (for example, the exercise habits that you learn while growing up) may have a profound effect on whether you exercise regularly as an adult. Still, there are differences between people with respect to how hard they must train to become physically fit. For some people, it comes easier than for others-in part, because of their genetic makeup. 例如，无论你是否有遗传倾向成为运动员，刻苦训练都会提高你的运动能力。此外，环境（例如你成长过程中学到的锻炼习惯）可能对你成年后是否定期锻炼产生深远影响。不过，不同人在变得身体健康所需的训练强度上存在差异。对某些人来说，这比其他人更容易——部分原因是他们的基因构成。
The same reasoning holds true for social anxiety. A genetic predisposition to have high levels of social anxiety and shyness simply means that you may have to work harder at overcoming the problem than someone who doesn’t have such a tendency. 同样的道理也适用于社交焦虑。遗传上倾向于具有较高的社交焦虑和害羞水平，仅意味着你可能需要比没有这种倾向的人付出更多努力来克服这个问题。
Effects of the Brain and Neurotransmitters 大脑和神经递质的影响
Compared with other psychological problems, including other anxiety disorders, studies examining the biological factors underlying social anxiety often have failed to obtain significant findings. For example, research examining hormonal factors, sleep patterns, and heart functioning has often failed to find differences between people with social anxiety disorder and people without significant social anxiety. 与其他心理问题（包括其他焦虑障碍）相比，研究社交焦虑背后生物因素的研究往往未能获得显著的发现。例如，研究激素因素、睡眠模式和心脏功能的研究，常常未能发现社交焦虑障碍患者与没有显著社交焦虑的人之间的差异。
However, a number of studies have found increased levels of activity in particular parts of the brain during periods of social anxiety. For example, scientists have found that people with social anxiety disorder experience increased activity in a part of the brain called the amygdala when looking at pictures of harsh faces (Phan et al. 2006; Stein et al. 2002; Straube et al. 2004). The amygdala is part of the limbic system and is activated when we experience the emotion of fear. During public speaking, there also appears to be more activation in the amygdala among people with social anxiety disorder than among people without this problem (Phan et al. 2006). 然而，许多研究发现，在社交焦虑期间，大脑特定部位的活动水平有所增加。例如，科学家发现，社交焦虑障碍患者在观看严厉面孔的图片时，大脑中被称为杏仁核的部分活动增加（Phan 等，2006；Stein 等，2002；Straube 等，2004）。杏仁核是边缘系统的一部分，当我们体验恐惧情绪时会被激活。在公开演讲时，社交焦虑障碍患者的杏仁核激活程度也明显高于没有此问题的人（Phan 等，2006）。
As reviewed by Britton and Rauch (in press), other areas of the brain that have been found to be activated during social anxiety include the anterior cingulate cortex (an area that is involved in controlling emotions, thought, and heart rate, among other functions), the medial prefrontal cortex (a section of the brain that is involved in complex cognition, personality expression, and social behavior), the insular cortex (a section of the limbic system that is involved in the experience of basic emotions, including fear), and the bippocampus (a part of the limbic system that controls memory and spatial abilities). Furthermore, treatment of social anxiety with either cognitive behavioral therapy or medication leads to reductions in activity in the amygdala and hippocampus (Furmark et al. 2002). 正如 Britton 和 Rauch（即将出版）所综述的，其他在社交焦虑期间被发现活跃的大脑区域包括前扣带皮层（一个参与控制情绪、思维和心率等功能的区域）、内侧前额叶皮层（大脑中涉及复杂认知、个性表达和社会行为的部分）、岛叶皮层（边缘系统的一部分，参与基本情绪体验，包括恐惧）以及海马体（边缘系统的一部分，控制记忆和空间能力）。此外，采用认知行为疗法或药物治疗社交焦虑均可导致杏仁核和海马体活动的减少（Furmark 等，2002 年）。
Studies examining the role of neurotransmitters (the chemicals responsible for transmitting information throughout the brain) in social anxiety have yielded mixed results (McCabe and Antony, in press). Some studies suggest that the neurotransmitter dopamine may be involved in social anxiety, whereas other studies have failed to replicate these findings. Studies regarding the role of serotonin (another neurotransmitter) have also yielded mixed findings. However, medications that work on the serotonin system have consistently been found to be helpful for decreasing the symptoms of social anxiety disorder (more on this in chapter 5). 研究神经递质（负责在大脑中传递信息的化学物质）在社交焦虑中的作用的研究结果不一（McCabe 和 Antony，待发表）。一些研究表明神经递质多巴胺可能与社交焦虑有关，而其他研究未能重复这些发现。关于血清素（另一种神经递质）作用的研究也得出了混合的结果。然而，作用于血清素系统的药物已被一致发现有助于减轻社交焦虑障碍的症状（更多内容见第 5 章）。
PSYCHOLOGICAL FACTORS 心理因素
In addition to biology, people’s experiences and beliefs also contribute to whether they develop difficulties with social anxiety and shyness. The ways in which learning and beliefs contribute to social anxiety are discussed in this section. 除了生物因素外，个人的经历和信念也会影响他们是否会出现社交焦虑和害羞的问题。本节将讨论学习和信念如何促成社交焦虑。
How Learning Contributes to Social Anxiety 学习如何促成社交焦虑
A large number of studies suggests that learning plays an important role in the development of fear. We learn to fear objects and situations through three main routes (Rachman 1976). First, directly experiencing a trauma or some negative consequence in a particular situation can lead to fear. For example, being bitten by a dog can teach a person to be afraid of dogs. Second, observing other people who are afraid of a situation can teach a person to be nervous. So, people may be more nervous behind the wheel of a car if they grew up with a parent who was an anxious driver. Finally, hearing or reading about the dangers of a particular situation can help to cause or maintain a person’s fear. For instance, reading about airline crashes can help to strengthen a person’s fear of flying. 大量研究表明，学习在恐惧的发展中起着重要作用。我们通过三种主要途径学习害怕物体和情境（Rachman 1976）。首先，直接经历某种创伤或在特定情境中遭遇负面后果会导致恐惧。例如，被狗咬过的人会学会害怕狗。其次，观察其他人害怕某种情境也会让人变得紧张。因此，如果一个人在有焦虑驾驶习惯的父母身边长大，开车时可能会更加紧张。最后，听说或阅读有关某种情境危险的信息也会帮助引发或维持一个人的恐惧。例如，阅读有关航空事故的报道会加深一个人对飞行的恐惧。
LEARNING BY DIRECT EXPERIENCE 通过直接体验学习
A history of negative experiences in social situations can increase a person’s shyness and social anxiety. For example, in a study from our center, people with social anxiety disorder were more likely to describe a history of severe teasing in childhood than were people with other anxiety problems (McCabe et al. 2003). In addition to teasing, other examples of social traumas include: 在社交场合中经历过负面事件的历史，可能会增加一个人的害羞和社交焦虑。例如，在我们中心的一项研究中，患有社交焦虑障碍的人比患有其他焦虑问题的人更可能描述童年时期遭受严重嘲笑的经历（McCabe 等，2003）。除了嘲笑之外，其他社交创伤的例子包括：
Being bullied by other children while growing up 在成长过程中被其他孩子欺负
Having parents, friends, teachers, or employers who are overly critical 父母、朋友、老师或雇主过于苛刻
Doing something embarrassing in a social situation (such as making an obvious mistake, vomiting, having a panic attack, and so on) 在社交场合做了令人尴尬的事情（例如犯了明显的错误、呕吐、发生恐慌发作等）
In the space below, list examples of negative consequences that you have experienced in social situations that may have contributed to or helped to maintain your social anxiety. 在下面的空白处，列举你在社交场合中经历过的负面后果，这些后果可能促成或维持了你的社交焦虑。
Examples of Negative or "Traumatic" Experiences That May Have Contributed to My Social Anxiety 可能促成我社交焦虑的负面或“创伤性”经历示例
LEARNING BY OBSERVING OTHERS 通过观察他人学习
Observation is a powerful way of learning to fear specific objects and situations. This form of learning (also called vicarious learning) includes developing a fear by observing role models who themselves are anxious in social situations. Another form of observational learning involves witnessing another person experience a trauma in a social situation. Examples of observational learning experiences that could lead to the development of social anxiety include: 观察是一种强有力的学习方式，可以让人对特定的物体和情境产生恐惧。这种学习形式（也称为替代性学习）包括通过观察那些在社交场合中本身感到焦虑的榜样来发展恐惧。另一种观察学习形式是目睹他人在社交场合中经历创伤。可能导致社交焦虑发展的观察学习经历示例包括：
Growing up with family members who are very shy and who rarely socialize 在一个非常害羞且很少社交的家庭成员中长大
Watching a classmate be severely criticized by a teacher following a presentation 看到一位同学在做完演讲后被老师严厉批评
Seeing coworkers become very anxious while giving presentations 看到同事在做演讲时变得非常焦虑
Witnessing a friend being teased by other students at school 目睹朋友在学校被其他学生取笑
In the space below, list examples of observational learning experiences that may have contributed to or helped to maintain your social anxiety. 在下面的空白处，列举可能促成或帮助维持你社交焦虑的观察学习经历的例子。
Examples of Observational Learning Experiences That May Have Contributed to My Social Anxiety 可能促成我社交焦虑的观察学习经历示例
LEARNING THROUGH INFORMATION AND INDIRECT MEANS 通过信息和间接方式的学习
People can learn to fear social situations by reading about or being warned about the dangers of making a bad impression on others. Examples of situations that could lead to developing social anxiety through the transmission of information include: 人们可以通过阅读或被警告关于给他人留下不良印象的危险，从而学会害怕社交场合。通过信息传递可能导致社交焦虑发展的情境示例包括：
Being repeatedly told by parents that it is very important to always make a good impression 父母反复告诉你，始终给人留下好印象非常重要
Being exposed to messages in magazines and on television that your image is the most important thing about you, and that you are only as attractive as other people think you are 在杂志和电视中接收到的信息是，你的形象是关于你最重要的事情，你的吸引力取决于别人对你的看法
In the space below, list examples of informational learning experiences that may have contributed to, or helped to maintain, your social anxiety. 在下面的空白处，列举可能促成或维持你社交焦虑的信息性学习经历的例子。
Examples of Indirect or Informational Learning Experiences That May Have Contributed to My Social Anxiety 可能促成我社交焦虑的间接或信息性学习经历的例子
Why Only Some People Develop Extreme Social Anxiety 为什么只有部分人会发展出极端的社交焦虑
Although negative experiences, observational learning, and informational learning are common routes by which people develop fears, they are not enough to explain why some people develop social anxiety and others don’t. Almost everyone is exposed to negative experiences in social situations. At one time or another most of us are teased. We are all exposed to anxiety-provoking messages at home, as well as through the media. And yet, not everyone develops a problem with social anxiety. Why is this so? 尽管负面经历、观察学习和信息学习是人们产生恐惧的常见途径，但这些还不足以解释为什么有些人会发展出社交焦虑，而有些人则不会。几乎每个人都会在社交场合中经历负面事件。我们大多数人或多或少都会被取笑。我们都在家庭环境以及通过媒体接触到引发焦虑的信息。然而，并非每个人都会出现社交焦虑问题。这是为什么呢？
Most likely, there are other factors that influence whether a particular person develops problems with social anxiety following a history of negative social experiences. These can include biological factors, such as a person’s genetic makeup. Previous learning experiences and the ways in which someone deals with his or her negative social experiences may also influence the development of fear. For example, a person who is ridiculed the first time he or she gives a presentation may be more likely to develop a fear of public speaking than someone who is ridiculed on a single occasion after having given many successful presentations previously. Similarly, someone who is severely teased at school may be protected from developing problems with social anxiety if he or she receives support from close friends after the episode. 很可能还有其他因素影响某人在经历负面社交经历后是否会发展出社交焦虑问题。这些因素可能包括生物学因素，例如一个人的基因构成。以往的学习经历以及一个人处理负面社交经历的方式也可能影响恐惧的发展。例如，第一次做演讲时被嘲笑的人，比起之前多次成功演讲后仅被嘲笑一次的人，更有可能产生对公开演讲的恐惧。同样，在学校被严重取笑的人，如果在事件发生后得到亲密朋友的支持，可能会避免发展出社交焦虑问题。
Finally, avoiding a social situation following a traumatic experience may increase the chances of developing social anxiety. You have probably heard that the best thing to do after falling off a horse is to get back on as soon as possible to avoid developing a fear of horses. The same is true of social anxiety. If you avoid a social situation following a traumatic experience, you may increase your chances of developing a fear of that situation. 最后，在经历创伤性事件后回避社交场合可能会增加发展社交焦虑的几率。你可能听说过，摔下马后最好的做法是尽快重新骑上马，以避免对马产生恐惧。社交焦虑也是如此。如果你在经历创伤性事件后回避社交场合，可能会增加你对该情境产生恐惧的几率。
HOW BELIEFS CONTRIBUTE TO SOCIAL ANXIETY 信念如何助长社交焦虑
As discussed in chapters 1 and 6, people with elevated social anxiety tend to think about social situations in a more negative way than do those people who are less anxious. Anxiety-provoking thoughts, interpretations, and predictions can lead someone to feel fear and anxiety in social situations. 如第 1 章和第 6 章所述，社交焦虑较高的人往往比焦虑较低的人更倾向于以负面的方式看待社交情境。引发焦虑的想法、解读和预测会导致人在社交场合感到恐惧和焦虑。
There are numerous studies investigating the role of thinking in social anxiety. There is also evidence that helping people to change their anxious beliefs is an effective way of decreasing their social anxiety. Research on thinking and social anxiety is reviewed elsewhere (Antony and Swinson 2000; Hirsch and Clark 2004). Some of the highlights of this research include the following findings: 有大量研究探讨了思维在社交焦虑中的作用。也有证据表明，帮助人们改变其焦虑信念是减少社交焦虑的有效方法。关于思维与社交焦虑的研究在其他文献中已有综述（Antony 和 Swinson 2000；Hirsch 和 Clark 2004）。这方面研究的一些重点发现包括以下内容：
People who experience high social anxiety rate negative social events as more likely to occur and more costly (in terms of their consequences), in comparison with people who don’t have significant social anxiety. 经历高度社交焦虑的人比那些没有显著社交焦虑的人更倾向于认为负面的社交事件更可能发生且代价更大（就其后果而言）。
These people tend to interpret their own performance (such as during a conversation or a speech) more critically than do people who are lower in social anxiety. 这些人倾向于比社交焦虑较低的人更批判性地解读自己的表现（例如在对话或演讲中）。
They tend to overestimate the extent to which their physical symptoms (such as blushing) are visible to others. 他们倾向于高估自己的身体症状（如脸红）被他人察觉的程度。
They are more likely than less anxious people to assume that others will interpret their physical symptoms (shaking, sweating, and so on) as a sign of a serious problem with anxiety or some mental illness. In contrast, people who are not socially anxious are less concerned about others noticing their physical arousal symptoms. Instead, people without significant social anxiety assume that others will interpret their physical symptoms as normal (perhaps a sign of feeling hot, being hungry, and so on). 他们比焦虑较轻的人更可能假设他人会将他们的身体症状（颤抖、出汗等）解读为严重焦虑问题或某种精神疾病的迹象。相比之下，不存在社交焦虑的人较少担心他人注意到他们的身体唤醒症状。相反，没有显著社交焦虑的人假设他人会将他们的身体症状解读为正常现象（可能是感到热、饥饿等的表现）。
When presented with an ambiguous social situation (for example, a stare from someone else or a phone call that isn’t returned), people with elevated social anxiety have a heightened tendency to interpret the situation negatively. 当面对模糊的社交情境时（例如，别人盯着看或电话未被接听），社交焦虑较高的人更倾向于将情境解读为负面。
Social anxiety is associated with a tendency to rate ambiguous or neutral faces as having a more negative expression. 社交焦虑倾向于将模糊或中性的面孔评为具有更负面的表情。
Compared with people who are less anxious, people with social anxiety disorder tend to pay more attention to information that represents social threat than to nonthreatening information. For example, when asked to look at lists of words, people who are socially anxious spend more time looking at words 与焦虑较轻的人相比，社交焦虑障碍患者更倾向于关注代表社交威胁的信息，而非无威胁的信息。例如，当被要求查看单词列表时，社交焦虑者会花更多时间注视某些单词
that are related to social anxiety (words such as “blush” or “party”) than do those who are less anxious. 与社交焦虑相关的词汇（如“脸红”或“聚会”）比那些焦虑较轻的人更容易被注意到。
Social anxiety is associated with a tendency to have a better memory and recognition for other people’s faces, particularly if the expression on the face appears to be negative or critical. 社交焦虑与对他人面孔的记忆和识别能力较强有关，尤其是当面部表情看起来是负面或批评性的时。
Taken together, these studies suggest that social anxiety and social anxiety disorder are associated with thinking styles that may actually make the problem worse. In chapter 6 , we’ll discuss ways to change your anxious thoughts and replace them with less anxious and more realistic ways of thinking. A number of studies investigating the effects of cognitive behavioral therapy on the negative thinking styles often associated with social anxiety have found that treatment leads to a reduction in negative thinking (Hirsch and Clark 2004) 综合来看，这些研究表明社交焦虑和社交焦虑障碍与某些思维方式有关，而这些思维方式实际上可能使问题恶化。在第 6 章中，我们将讨论改变焦虑思维的方法，并用较少焦虑且更现实的思维方式取代它们。多项研究调查了认知行为疗法对社交焦虑常见的负面思维方式的影响，发现治疗能减少负面思维（Hirsch 和 Clark 2004）。
HOW BEHAVIORS CONTRIBUTE TO SOCIAL ANXIETY 行为如何助长社交焦虑
As discussed in chapter 1, avoidance of social situations can have the effect of increasing social anxiety over the long term. In other words, the strategy that people who are socially anxious use most frequently to cope with their fear may actually make the problem worse. 如第 1 章所述，回避社交场合从长远来看可能会加剧社交焦虑。换句话说，社交焦虑者最常用来应对恐惧的策略实际上可能使问题更加严重。
In addition, some behaviors that people use to protect themselves in social situations can actually lead to the very outcome that people with social anxiety disorder fear most-a negative reaction from others. For example, if when talking to other people at a party, you speak very quietly, avoid eye contact, and avoid expressing your views and opinions, people may choose to talk to someone else. They may interpret your behavior as a sign that you’re not interested in talking or that you are a difficult person to get to know. See chapters 7 through 9 for a discussion of strategies for confronting feared situations instead of avoiding them and for stopping the safety behaviors that help to maintain your fear over time. And, in chapter 10, we’ll discuss strategies for improving communication and social skills. 此外，人们在社交场合中用来保护自己的某些行为，实际上可能导致社交焦虑症患者最害怕的结果——他人的负面反应。例如，如果你在聚会上与他人交谈时说话声音很小，避免眼神交流，也不表达自己的观点和看法，人们可能会选择去和别人交谈。他们可能会将你的行为解读为你对交谈不感兴趣，或者你是一个难以接近的人。第 7 至 9 章将讨论面对恐惧情境而非回避它们的策略，以及如何停止那些随着时间推移维持你恐惧的安全行为。在第 10 章，我们将讨论改善沟通和社交技能的策略。
CHAPTER 3 第三章
Getting to Know Your Social Anxiety 了解你的社交焦虑
WHY CONDUCT A SELF-ASSESSMENT? 为什么要进行自我评估？
The initial step that a psychologist, psychiatrist, or other mental health professional takes in beginning to help an individual with a particular problem is a period of evaluation and assessment. This evaluation process involves collecting information needed to better understand the nature and extent of the problem so that the best possible treatment plan can be formulated. This initial assessment almost always involves an interview and may also include various questionnaires and standard tests. Sometimes, the therapist may ask the person to start keeping a diary to monitor specific thoughts or behaviors. 心理学家、精神科医生或其他心理健康专业人员在开始帮助个体解决特定问题时的第一步是进行评估和测量阶段。这个评估过程包括收集所需信息，以便更好地理解问题的性质和程度，从而制定出最佳的治疗方案。这个初步评估几乎总是包括一次面谈，有时还会包括各种问卷和标准测试。有时，治疗师可能会要求当事人开始记日记，以监测特定的想法或行为。
In the case of social anxiety, a clinician might spend the first session (or even the first few sessions) asking questions about the client’s social anxiety, about other difficulties he or she might be experiencing, and about the person’s general background and life experiences. The individual also may be asked to answer a series of questionnaires that measure social anxiety and related problems. In addition, the client is often asked to complete diary entries between sessions to measure the person’s anxiety in social situations, his or her feelings of depression, and any other aspects of the problem. The assessment process helps the clinician to understand the person’s problems and is useful for choosing an appropriate course of treatment. In addition, repeating certain assessments from time to time allows the clinician to measure whether treatment is working (Antony and Rowa 2005). 在社交焦虑的情况下，临床医生可能会在第一次会面（甚至前几次会面）中询问有关客户社交焦虑的问题、他或她可能遇到的其他困难，以及该人的一般背景和生活经历。个体还可能被要求填写一系列测量社交焦虑及相关问题的问卷。此外，客户通常被要求在会面之间完成日记条目，以记录其在社交场合中的焦虑程度、抑郁感受以及问题的其他方面。评估过程有助于临床医生了解该人的问题，并有助于选择合适的治疗方案。此外，不时重复某些评估可以让临床医生衡量治疗是否有效（Antony 和 Rowa 2005）。
In the same way, a detailed self-assessment will help you to understand and address your difficulties with social anxiety. We strongly recommend that, before you begin working on changing your own social anxiety, you carry out a careful self-assessment. This assessment process will have the following four main benefits. It will: 同样，详细的自我评估将帮助你理解并解决社交焦虑的问题。我们强烈建议你在开始改变自己的社交焦虑之前，先进行一次仔细的自我评估。这个评估过程将带来以下四个主要好处。它将：
Allow you to measure the severity of your social anxiety 让你能够衡量社交焦虑的严重程度
Help you to identify key problem areas 帮助你识别关键问题领域
Make it easier to choose the most appropriate treatment strategies 使你更容易选择最合适的治疗策略
Provide you with an opportunity to measure your improvement as you use the strategies described in this book 为您提供一个机会，以便在使用本书中描述的策略时衡量您的进步
Now we will discuss each of these issues in greater detail. 现在我们将更详细地讨论这些问题。
MEASURING THE SEVERITY OF YOUR SOCIAL ANXIETY 衡量您社交焦虑的严重程度
The term “severity” takes into account such variables as (1) the intensity of your fear in social and performance situations, (2) the range of different situations that precipitate your social anxiety, (3) the frequency with which you experience intense social anxiety, (4) the effect of your social anxiety on your day-to-day life, career, and relationships, and (5) the extent to which being socially anxious bothers you. Generally, as the severity of social anxiety increases, typically, so does the intensity of the fear, the number of situations that are affected, the frequency with which anxiety is experienced, the level of interference with day-to-day functioning, and the extent to which a person is bothered by having the fear. “严重程度”一词考虑了以下变量：（1）您在社交和表演场合中恐惧的强度，（2）引发您社交焦虑的不同情境范围，（3）您经历强烈社交焦虑的频率，（4）社交焦虑对您日常生活、职业和人际关系的影响，以及（5）社交焦虑给您带来的困扰程度。通常，随着社交焦虑严重程度的增加，恐惧的强度、受影响的情境数量、焦虑发生的频率、对日常功能的干扰程度以及因恐惧而感到困扰的程度通常也会增加。
IDENTIFYING WHICH PROBLEMS TO WORK ON 确定要解决的问题
If you’re like many people, you probably experience anxiety in a number of different social situations. A comprehensive self-assessment will help you to decide which fears to work on first. First, it will be important to identify which situations you fear and avoid. Next, you will need to identify your priorities-that is, which aspects of the problem you want to begin to address first. When choosing your priorities, here are some suggestions to keep in mind: 如果你和许多人一样，可能在多种社交场合中都会感到焦虑。全面的自我评估将帮助你决定先解决哪些恐惧。首先，重要的是要确定你害怕并回避的情境。接下来，你需要确定你的优先事项——也就是说，决定先从问题的哪些方面入手。当选择优先事项时，可以参考以下建议：
Begin working on problems for which you are likely to see quick changes. Early improvements will help to motivate you to work on more difficult situations. 先着手解决那些你可能很快看到变化的问题。早期的改善将激励你继续应对更困难的情境。
Try to work on fears that interfere the most with your day-to-day life. Being able to confront the most disabling fears will have a much bigger impact on your life than working on fears that are less important to you. 尝试解决那些最干扰你日常生活的恐惧。能够面对最让你受限的恐惧，对你的生活影响远大于解决那些对你来说不那么重要的恐惧。
If one of your treatment aims is very important to you but is just too overwhelming to deal with, divide that goal into smaller, more manageable objectives. For example, if you are afraid of dating, you could work on your fear by breaking the situation down into steps such as saying hello to an attractive classmate, sitting beside the classmate for several weeks in a row, speaking with the classmate after class, offering to study with the classmate, and asking the classmate to have dinner with you after class. 如果你的某个治疗目标对你非常重要，但又让你感到难以应对，可以将该目标分解成更小、更易管理的任务。例如，如果你害怕约会，可以通过将情境分解成几个步骤来应对恐惧，比如向一位有吸引力的同学打招呼，连续几周坐在该同学旁边，下课后与该同学交谈，主动提出一起学习，最后邀请该同学下课后共进晚餐。
CHOOSING THE BEST STRATEGIES FOR CHANGE 选择最佳的改变策略
A self-assessment also can help you to decide which treatment strategies to use. In many cases, the specific treatment approaches you select will be directly related to factors you identify in your self-assessment. Consider the following examples of how an assessment can help you to select the best approaches for treatment: 自我评估也能帮助你决定使用哪些治疗策略。在许多情况下，你选择的具体治疗方法将直接与你在自我评估中识别的因素相关。请考虑以下评估如何帮助你选择最佳治疗方法的示例：
Identifying which situations you fear and avoid will help you to choose which situations to select for exposure practices (as described in chapters 7 and 8). 识别你害怕和回避的情境将帮助你选择用于暴露练习的情境（如第 7 章和第 8 章所述）。
Identifying the extent to which you are fearful of the physical feelings that you experience when you are anxious will help determine whether you should practice exposure to uncomfortable physical sensations (as described in chapter 9). 确定你对焦虑时所体验到的身体感觉的恐惧程度，有助于判断你是否应该练习暴露于不适的身体感觉中（如第 9 章所述）。
Assessing those areas in which your social skills can be improved will help you to decide whether to spend time working on the skills involved in assertiveness, public speaking, dating, or general communication. (See chapter 10 for strategies for improving various types of social and communication skills.) 评估你社交技能中可以改进的方面，将帮助你决定是否花时间提升自信表达、公众演讲、约会或一般沟通等技能。（有关提升各种社交和沟通技能的策略，请参见第 10 章。）
If you decide to take medications for your social anxiety, the choice of which medication to try will depend on your previous response to medications, possible interactions with other medications you take, medical conditions you may have, side effects that you are willing to tolerate, as well as a number of other factors. If you are considering using medications, thinking about these issues should be part of your self-assessment (see chapter 5). 如果你决定服用药物治疗社交焦虑，选择哪种药物将取决于你之前对药物的反应、你正在服用的其他药物可能产生的相互作用、你可能存在的医疗状况、你愿意忍受的副作用，以及其他多种因素。如果你考虑使用药物，思考这些问题应成为你自我评估的一部分（见第 5 章）。
MEASURING YOUR IMPROVEMENT 衡量你的进步
Assessment is not only for the initial phase of your treatment. Rather, the process of assessment should continue throughout treatment and even after treatment has ended. Continuing the assessment process throughout treatment will provide you with a way of measuring how much your social anxiety has improved as a result of using the strategies described in this book. Also, conducting occasional self-assessments after treatment has ended will let you know whether your treatment gains have continued over time. 评估不仅仅是在治疗的初始阶段进行。相反，评估过程应贯穿整个治疗过程，甚至在治疗结束后继续进行。在整个治疗过程中持续进行评估，可以让你衡量使用本书中描述的策略后，社交焦虑改善了多少。此外，在治疗结束后偶尔进行自我评估，可以让你了解治疗效果是否随着时间持续保持。
STEP-BY-STEP GUIDE FOR CONDUCTING A SELF-ASSESSMENT 自我评估的逐步指南
Therapists and clinicians who treat social anxiety use a number of tools to assess clients and patients. The most common of these include the following. 治疗社交焦虑的治疗师和临床医生使用多种工具来评估客户和患者。其中最常见的包括以下几种。
Clinical Interviews 临床访谈
Interviews involve asking a person specific questions about his or her background, anxiety symptoms, and related problems. It is an easy way of getting to know someone and learning about his or her difficulties simply by talking. 访谈包括向某人询问有关其背景、焦虑症状及相关问题的具体问题。这是一种通过交谈轻松了解某人及其困难的方式。
Questionnaires 问卷
Questionnaires include paper-and-pencil tests that a person completes before beginning treatment, and perhaps again during treatment and after treatment ends. They are used to provide additional information not covered in the interview, as well as to confirm and expand upon the information provided in the interview. 问卷包括在开始治疗前由个人填写的纸笔测试，可能还会在治疗过程中和治疗结束后再次填写。它们用于提供访谈中未涵盖的额外信息，以及确认和扩展访谈中提供的信息。
Diaries 日记
Diaries are completed on a day-to-day basis between therapy sessions. They are useful because they provide the individual with an opportunity to record his or her thoughts and feelings as they occur, rather than having to remember all of the details of a complex event later. 日记是在治疗会话之间按日完成的。它们很有用，因为它们为个人提供了一个机会，记录他或她当时的想法和感受，而不必事后记住复杂事件的所有细节。
Behavioral Assessment 行为评估
A behavioral assessment involves directly observing a person’s behavior or asking the person to perform a specific behavior and then measuring the thoughts and feelings that arise in that situation. The most common types of behavioral assessment for social 行为评估包括直接观察一个人的行为，或要求该人执行特定行为，然后测量在该情境中产生的想法和感受。社交焦虑最常见的行为评估类型是行为接近测试和行为角色扮演。
anxiety are the behavioral approach test and behavioral role-play. These involve having a person enter a feared social situation (behavioral approach test) or act out a feared situation in a role-play (behavioral role-play) and having the person report his or her fear level, anxious thoughts, and other experiences. 这些方法包括让一个人进入一个害怕的社交情境（行为接近测试）或在角色扮演中演绎一个害怕的情境（行为角色扮演），并让该人报告他或她的恐惧程度、焦虑想法及其他体验。
Although these assessments are usually conducted by a psychologist, psychiatrist, or other professional, each can be adapted to be part of your self-assessment. We recommend that your assessment include the following three steps: 虽然这些评估通常由心理学家、精神科医生或其他专业人士进行，但每一种评估都可以调整为自我评估的一部分。我们建议你的评估包括以下三个步骤：
Conduct a self-interview. For example, answer important questions about your anxiety and related problems. 进行自我访谈。例如，回答关于你的焦虑及相关问题的重要问题。
Complete anxiety diaries. An example is the Three Components of Social Anxiety Monitoring Form included in chapter 1. 填写焦虑日记。一个例子是第一章中包含的社交焦虑三要素监测表。
Complete a behavioral approach test or role-play. 完成行为接近测试或角色扮演。
Conducting a Self-Interview 进行自我访谈
Any professional contact with a psychologist, psychiatrist, or other mental health professional typically begins with a clinical interview, during which the clinician asks the client or patient questions about his or her problems. The interview helps the clinician to identify the most important features of the problem and is a first step toward developing an effective treatment plan. To be consistent with this goal, we suggest that you conduct a self-interview, in which you answer important questions about your problem. 任何与心理学家、精神科医生或其他心理健康专业人士的专业接触，通常都始于临床访谈，期间临床医生会向客户或患者询问有关其问题的问题。访谈帮助临床医生识别问题的最重要特征，是制定有效治疗计划的第一步。为了与这一目标保持一致，我们建议你进行自我访谈，回答关于你问题的重要问题。
To help you with this process, we have identified ten basic questions you should try to answer at the start of your self-assessment. The answers to these questions will help you to do the following: decide whether social anxiety is in fact a problem for you; identify the factors that contribute to your social anxiety; and choose the specific situations that you need to work on most. At the beginning of chapter 4, we will suggest additional questions that will help you to develop a treatment plan. 为了帮助你完成这一过程，我们确定了十个基本问题，你应在自我评估开始时尝试回答。这些问题的答案将帮助你做到以下几点：判断社交焦虑是否确实是你的问题；识别导致你社交焦虑的因素；选择你最需要努力解决的具体情境。在第 4 章开始时，我们将提出更多问题，帮助你制定治疗计划。
WHICH SOCIAL SITUATIONS DO YOU FEAR AND AVOID? 你害怕并回避哪些社交情境？
For each of the following situations (divided into interpersonal situations and performance situations, as defined in chapter 1), record a number ranging from 0 to 100 to rate (1) the extent to which you fear the situation during a typical or average encounter and (2) the extent to which you typically avoid the situation. For example, if you have an intense fear of making presentations but you avoid the situation only about half the time, your fear rating might be an 80 and your avoidance rating might be a 50 . If the situation is one that you never encounter, base your ratings on how fearful you imagine you would be in the situation and how much you would avoid the situation if it did come up from time to time. Use the following scales to rate your fear and avoidance levels. 对于以下每种情境（分为第一章中定义的人际情境和表现情境），请记录一个介于 0 到 100 之间的数字，分别评估（1）你在典型或平均遇到该情境时的恐惧程度，以及（2）你通常避免该情境的程度。例如，如果你对做演讲有强烈的恐惧，但你只在大约一半的时间里避免这种情境，那么你的恐惧评分可能是 80，避免评分可能是 50。如果该情境是你从未遇到过的，请根据你想象中在该情境下的恐惧程度以及如果偶尔遇到该情境你会避免的程度来给出评分。请使用以下量表来评估你的恐惧和避免程度。
Item 项目
Asking someone out on a date 约某人出去约会
Starting a conversation with a classmate or coworker 与同学或同事开始对话
Going to a party 参加聚会
Having friends over for dinner 邀请朋友来家里吃饭
Being introduced to new people 被介绍给新朋友
Talking on the telephone with a friend 与朋友通电话
Talking on the telephone with a stranger 与陌生人通电话
Expressing a personal opinion (for instance, expressing your views about a movie that you saw recently or a book that you’ve read) 表达个人观点（例如，表达你对最近看过的电影或读过的书的看法）
Being interviewed for a job 接受工作面试
Being assertive (such as refusing an unreasonable request) 坚持自我（例如拒绝不合理的请求）
Returning an item to a store 将商品退回商店
Sending back food in a restaurant 在餐厅退回食物
Making eye contact 进行眼神交流
Other (specify) qquad\qquad 其他（请说明） qquad\qquad
Other (specify) qquad\qquad 其他（请说明） qquad\qquad
Other (specify) qquad\qquad 其他（请说明） qquad\qquad
Performance Situations (being observed by others) 表现情境（被他人观察）
Fear 恐惧
Avoidance 回避
Item 项目
Giving a presentation at work 在工作中做演讲
Making a toast at a party or family gathering 在聚会或家庭聚餐上敬酒
Speaking in meetings at work or school 在工作或学校的会议上发言
Playing sports or participating in aerobics in front of others 在他人面前进行体育运动或参加有氧运动
Standing in a wedding party at someone else's wedding 在别人的婚礼上作为婚礼队伍的一员站立
Singing or performing music in front of others 在别人面前唱歌或表演音乐
Eating or drinking in front of others 在别人面前吃东西或喝东西
Using public bathrooms with others in the room 在有他人在场的公共厕所使用
Writing with others watching (such as signing a check) 在别人注视下写字（例如签支票）
Making a mistake in public (for instance, mispronouncing a word) 在公共场合犯错（例如，发错音）
Walking or jogging in a busy public place 在繁忙的公共场所走路或慢跑
Introducing yourself in front of a group 在一群人面前自我介绍
Shopping in a busy store 在繁忙的商店购物
Other (specify) 其他（请说明）
qquad\qquad
Other (specify) 其他（请说明）
qquad\qquad
Other (specify) 其他（请说明）
Fear Avoidance Item
Giving a presentation at work
Making a toast at a party or family gathering
Speaking in meetings at work or school
Playing sports or participating in aerobics in front of others
Standing in a wedding party at someone else's wedding
Singing or performing music in front of others
Eating or drinking in front of others
Using public bathrooms with others in the room
Writing with others watching (such as signing a check)
Making a mistake in public (for instance, mispronouncing a word)
Walking or jogging in a busy public place
Introducing yourself in front of a group
Shopping in a busy store
Other (specify)
qquad Other (specify)
qquad Other (specify)| Fear | Avoidance | Item |
| :--- | :--- | :--- |
| | | Giving a presentation at work |
| | | Making a toast at a party or family gathering |
| | | Speaking in meetings at work or school |
| | | Playing sports or participating in aerobics in front of others |
| | | Standing in a wedding party at someone else's wedding |
| | | Singing or performing music in front of others |
| | | Eating or drinking in front of others |
| | | Using public bathrooms with others in the room |
| | | Writing with others watching (such as signing a check) |
| | | Making a mistake in public (for instance, mispronouncing a word) |
| | | Walking or jogging in a busy public place |
| | | Introducing yourself in front of a group |
| | | Shopping in a busy store |
| | | Other (specify) |
| | $\qquad$ | Other (specify) |
| | $\qquad$ | Other (specify) |
WHICH VARIABLES MAKE YOUR ANXIETY BETTER OR WORSE? 哪些变量会使你的焦虑加重或缓解？
An important step in your self-assessment is to become aware of the variables that make your fear better or worse in a given situation. For example, if you are fearful of eating with other people, there are many factors that could influence your fear in this situation, including who you’re eating with, where you’re eating, and what you’re eating. Identifying the variables that affect your level of fear in a particular situation will help you to set up appropriate practices when you begin to use the exposure-based techniques discussed later in this book. 在自我评估中，一个重要的步骤是意识到在特定情境下使你的恐惧加重或减轻的变量。例如，如果你害怕与他人一起吃饭，那么在这种情境中可能影响你恐惧感的因素有很多，包括你与谁一起吃饭、在哪里吃饭以及你吃的是什么。识别出影响你在特定情境中恐惧程度的变量，将帮助你在开始使用本书后面讨论的基于暴露的技术时，制定合适的练习方案。
Following is a list of variables that sometimes affect a person’s fear and anxiety in social situations. For each item, record a number ranging from 0 to 100 to rate the extent to which the variable listed affects your level of fear or discomfort in the types of social situations that you fear. For example, if you are much more anxious when talking to a woman than when talking to a man, you might rate the effect of the other person’s sex on your anxiety at about a 75 or 80 . Use the following scale to obtain your rating. 以下是一些有时会影响人在社交情境中恐惧和焦虑的变量列表。对于每一项，请记录一个从 0 到 100 的数字，来评估该变量在你害怕的社交情境中对你的恐惧或不适程度的影响。例如，如果你在与女性交谈时比与男性交谈时更焦虑，你可能会将对方性别对你焦虑的影响评为 75 或 80 左右。请使用以下量表来给出你的评分。
Aspects of the Other Person and their Effect on Your Discomfort 对方的各个方面及其对你不适感的影响
Effect Item on Your Discomfort 影响你不适感的因素
qquad\qquad Age (whether the other person is older, younger, or the same age as you) qquad\qquad 年龄（对方是比你年长、年幼，还是同龄） qquad\qquad Sex of the other person (same sex, opposite sex) qquad\qquad 对方的性别（同性、异性） qquad\qquad Relationship status of the other person (married, dating someone, single) qquad\qquad 对方的感情状况（已婚、正在约会、单身） qquad\qquad Physical attractiveness of the other person qquad\qquad 对方的外貌吸引力 qquad\qquad Nationality or ethnic background of the other person qquad\qquad 对方的国籍或民族背景 qquad\qquad How confident the other person seems qquad\qquad 对方看起来有多自信 qquad\qquad How aggressive or pushy the other person seems qquad\qquad 对方看起来有多咄咄逼人或强势 qquad\qquad How interesting the other person appears to be qquad\qquad 对方看起来有多有趣 qquad\qquad Whether the person appears to have a good sense of humor qquad\qquad 这个人是否看起来有良好的幽默感 qquad\qquad How financially successful the other person seems to be qquad\qquad 对方看起来财务上有多成功 qquad\qquad How well dressed the other person appears to be qquad\qquad 对方看起来穿着有多得体 qquad\qquad Other (specify) qquad\qquadqquad\qquad 其他（请说明） qquad\qquad qquad\qquad Other (specify) qquad\qquadqquad\qquad 其他（请说明） qquad\qquad
My Relationship with the Other Person and Its Effect on Your Discomfort 我与对方的关系及其对您不适感的影响
Effect Item 影响项目on Your 关于你的Discomfort 不适感
qquad\qquad How well you know the other person (family member, close friend, acquaintance, stranger, and so on) qquad\qquad 你与对方的熟悉程度（家庭成员、亲密朋友、熟人、陌生人等） qquad\qquad How intimate and close you are to the other person qquad\qquad 你与对方的亲密程度 qquad\qquad Whether there is a history of conflict between yourself and the other person qquad\qquad 你与对方之间是否有冲突的历史 qquad\qquad The type of relationship between you and the other person (for example, supervisor, coworker, employee) qquad\qquad 你与对方之间的关系类型（例如，主管、同事、下属） qquad\qquad Other (specify) qquad\qquadqquad\qquad 其他（请说明） qquad\qquad qquad\qquad Other (specify) qquad\qquadqquad\qquad 其他（请说明） qquad\qquad
Aspects of How You Are Feeling and Its Effect on Your Discomfort 你感受的各个方面及其对你不适感的影响
Effect Item on Your Discomfort 对你不适感的影响因素
qquad\qquad How tired you are overall qquad\qquad 你整体的疲劳程度 qquad\qquad General level of stress in your life at the time qquad\qquad 你当时生活中的总体压力水平 qquad\qquad How familiar you are with the topic being discussed qquad\qquad 你对所讨论话题的熟悉程度 qquad\qquad How prepared you are before entering the situation (for example, whether you have had a chance to rehearse your presentation) qquad\qquad 你在进入情境前的准备情况（例如，你是否有机会排练你的演讲） qquad\qquad Other (specify) qquad\qquadqquad\qquad 其他（请说明） qquad\qquad qquad\qquad Other (specify) qquad\qquadqquad\qquad 其他（请说明） qquad\qquad
Aspects of the Situation and Their Effect on Your Discomfort 情境的各个方面及其对你不适感的影响
Effect Item on Your Discomfort 对你不适感的影响因素
qquad\qquad Lighting (for instance, the light level is so high that you feel that any sign of anxiety will be visible) qquad\qquad 光线（例如，光线强度过高，让你觉得任何焦虑的迹象都会被看见） qquad\qquad How formal the situation is (for example, eating at a wedding reception vs. a casual dinner with friends) qquad\qquad 情境的正式程度（例如，在婚礼招待会上用餐与和朋友随意共进晚餐） qquad\qquad Number of people involved (such as presenting to a few coworkers vs. presenting to a filled auditorium) qquad\qquad 参与人数（例如向几位同事演讲与向满座的礼堂演讲） qquad\qquad Activity involved (eating, speaking, writing, and so on) qquad\qquad 所涉及的活动（吃饭、说话、写作等） qquad\qquad Your physical position (seated, standing, and so on) qquad\qquad 你的身体姿势（坐着、站着等） qquad\qquad Whether you can use alcohol or drugs to feel more comfortable qquad\qquad 你是否可以使用酒精或药物来让自己感觉更舒适 qquad\qquad How long you’re stuck in the situation for qquad\qquad 你在这种情况下被困多久了 qquad\qquad Other (specify) qquad\qquadqquad\qquad 其他（请说明） qquad\qquad qquad\qquad Other (specify) qquad\qquadqquad\qquad 其他（请说明） qquad\qquad
WHAT ARE YOUR FEELINGS AND HOW DO YOU FEEL ABOUT THEM? 你的感受是什么？你对这些感受有什么看法？
Following is a list of physical feelings that people sometimes experience when they are feeling anxious, worried, or frightened. For each item, you should first record a number (from 0 to 100 ) that reflects the intensity of the feeling during a typical exposure to an anxiety-provoking social situation. A rating of 0 means that, typically, you do not experience the sensation at all, and a rating of 100 means that the sensation typically is extremely intense when you encounter social situations that are a problem for you. 以下是人们在感到焦虑、担忧或害怕时有时会经历的身体感觉列表。对于每一项，您应首先记录一个数字（从 0 到 100），反映在典型的引发焦虑的社交情境中该感觉的强度。评分为 0 表示您通常根本不会体验到这种感觉，评分为 100 表示当您遇到对您来说有问题的社交情境时，这种感觉通常非常强烈。
Next, using a scale from 0 to 100 , rate the extent to which you are fearful of experiencing the sensation in front of other people. A rating of 0 means that you are not at all concerned about experiencing the sensation in front of others and a rating of 100 means that you are extremely fearful of experiencing the sensation in front of others. 接下来，使用 0 到 100 的评分，评估您在他人面前体验这种感觉时的恐惧程度。评分为 0 表示您完全不担心在他人面前体验这种感觉，评分为 100 表示您极度害怕在他人面前体验这种感觉。
Intensity of the Physical Sensations Scale 身体感觉强度量表
Fear of Having the Physical Sensations in Front of Others Scale 害怕在他人面前出现身体感觉量表
0
10
20
30
40
50
60
70
80
90
100
No 无
Mild 轻度
Moderate 中度
Extreme 极端
Very 非常
Fear 恐惧
Fear 恐惧
Fear 恐惧
Fear 恐惧
Extreme 极度
Fear 恐惧
0 10 20 30 40 50 60 70 80 90 100
No Mild Moderate Extreme Very
Fear Fear Fear Fear Extreme
Fear | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 |
| :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: |
| No | | Mild | | | Moderate | | Extreme | | Very | |
| Fear | | Fear | | | Fear | | Fear | | Extreme | |
| | | | | | | | | | Fear | |
Intensity of Sensation 感觉的强度
Your Fear of Sensation 你对感觉的恐惧
Sensation 感觉
qquad\qquad
Racing or pounding heart 心跳加速或剧烈跳动
qquad\qquad
Breathlessness or smothering feelings 呼吸急促或窒息感
qquad\qquad
Dizziness or lightheadedness 头晕或头昏眼花
工
Difficulty swallowing, choking feelings, or a "lump" in the throat 吞咽困难、窒息感或喉咙有“异物感”
qquad\qquad
Quivering or shakiness (in the hands, knees, lips, or whole body) 颤抖或发抖（手、膝盖、嘴唇或全身）
Blushing 脸红
qquad\qquad
Nausea, diarrhea, or "butterflies" in the stomach 恶心、腹泻或胃部“蝴蝶飞舞”的感觉
qquad\qquad
Excessive sweating 过度出汗
qquad\qquad
Shaky voice 声音发抖
qquad\qquad
Tearfulness, crying 易流泪，哭泣
qquad\qquad
Poor concentration (forgetting what you're trying to say) 注意力不集中（忘记你想说的话）
qquad\qquad
Blurred vision 视线模糊
qquad\qquad
Numbness and tingling sensations 麻木和刺痛感
qquad\qquad
Feelings of unreality or being detached from your body or from things around you 感觉不真实或与自己的身体或周围事物脱节
qquad\qquad
Tightness, soreness, or weakness in the muscles 肌肉紧绷、酸痛或无力
qquad\qquad
Chest pain or tightness in chest muscles 胸痛或胸部肌肉紧绷
qquad\qquad
Dry mouth 口干
Hot flushes or chills 潮热或寒战
qquad\qquad
Other (specify) 其他（请说明）
qquad\qquad
Other (specify) 其他（请说明）
Intensity of Sensation Your Fear of Sensation Sensation
qquad Racing or pounding heart
qquad Breathlessness or smothering feelings
qquad Dizziness or lightheadedness
工 Difficulty swallowing, choking feelings, or a "lump" in the throat
qquad Quivering or shakiness (in the hands, knees, lips, or whole body)
Blushing
qquad Nausea, diarrhea, or "butterflies" in the stomach
qquad Excessive sweating
qquad Shaky voice
qquad Tearfulness, crying
qquad Poor concentration (forgetting what you're trying to say)
qquad Blurred vision
qquad Numbness and tingling sensations
qquad Feelings of unreality or being detached from your body or from things around you
qquad Tightness, soreness, or weakness in the muscles
qquad Chest pain or tightness in chest muscles
qquad Dry mouth
Hot flushes or chills
qquad Other (specify)
qquad Other (specify)| Intensity of Sensation | Your Fear of Sensation | Sensation |
| :--- | :--- | :--- |
| $\qquad$ | | Racing or pounding heart |
| | $\qquad$ | Breathlessness or smothering feelings |
| | $\qquad$ | Dizziness or lightheadedness |
| 工 | | Difficulty swallowing, choking feelings, or a "lump" in the throat |
| | $\qquad$ | Quivering or shakiness (in the hands, knees, lips, or whole body) |
| | | Blushing |
| | $\qquad$ | Nausea, diarrhea, or "butterflies" in the stomach |
| | $\qquad$ | Excessive sweating |
| | $\qquad$ | Shaky voice |
| | $\qquad$ | Tearfulness, crying |
| | $\qquad$ | Poor concentration (forgetting what you're trying to say) |
| | $\qquad$ | Blurred vision |
| | $\qquad$ | Numbness and tingling sensations |
| | $\qquad$ | Feelings of unreality or being detached from your body or from things around you |
| | $\qquad$ | Tightness, soreness, or weakness in the muscles |
| | $\qquad$ | Chest pain or tightness in chest muscles |
| | $\qquad$ | Dry mouth |
| | | Hot flushes or chills |
| | $\qquad$ | Other (specify) |
| | $\qquad$ | Other (specify) |
WHAT ARE YOUR ANXIETY-PROVOKING BELIEFS, PREDICTIONS, AND EXPECTATIONS? 你有哪些引发焦虑的信念、预测和期望？
As discussed in chapter 1, your beliefs have a big impact on how you feel in social situations. For example, if you expect that others will think you are stupid, weak, or unattractive, you are very likely to feel anxious around other people. On the other hand, if you are not especially concerned about what others think about you in a particular situation, you’re much more likely to feel comfortable. Often, our beliefs and predictions are not based on reality. For people who experience elevated anxiety in social and performance situations, beliefs and expectations about these situations are often negative. These thoughts tend to exaggerate the likelihood of danger and lead the person to expect the worst, even when there is no reason to do so. 正如第一章所讨论的，你的信念对你在社交场合中的感受有很大影响。例如，如果你预期别人会认为你愚蠢、软弱或不吸引人，你很可能会在人群中感到焦虑。另一方面，如果你并不特别在意别人对你在某个特定场合的看法，你就更有可能感到舒适。通常，我们的信念和预测并不基于现实。对于那些在社交和表现场合中感到高度焦虑的人来说，他们对这些场合的信念和期望往往是消极的。这些想法倾向于夸大危险的可能性，使人预期最坏的情况，即使没有理由这样做。
Cognitive therapy involves teaching people to identify and change their anxious beliefs, predictions, and expectations by considering more realistic alternative beliefs. Before you can change your thoughts, however, you need to be able to observe them and to decide whether they are unrealistic and whether they are contributing to your anxiety. 认知疗法包括教导人们识别并通过考虑更现实的替代信念来改变他们的焦虑信念、预测和期望。然而，在你能够改变自己的想法之前，你需要能够观察这些想法，并判断它们是否不现实，以及它们是否在助长你的焦虑。
Chapter 1 lists examples of thoughts and expectations that contribute to social anxiety. Some of these include basic assumptions, such as, “It is important that everyone likes me” and “Nobody will ever think I am interesting.” Other anxiety-provoking thoughts may be more focused on a particular situation, such as, “If I arrive at class early, I won’t be able to think of anything to say” and “People will think I am weird if they notice my hands shaking.” 第 1 章列举了一些导致社交焦虑的思维和期望的例子。其中一些是基本假设，例如，“每个人都喜欢我很重要”和“没人会觉得我有趣”。其他引发焦虑的想法可能更集中于特定情境，比如，“如果我提前到教室，我就想不出要说什么”和“如果别人注意到我手在发抖，他们会觉得我很奇怪”。
To identify your own anxiety-provoking thoughts, we recommend the following steps. First, review some of the examples of anxiety-provoking thoughts listed in chapter 1. These will give you an idea of the types of thoughts that are often associated with social anxiety. Next, think of social situations that you find particularly difficult (for example, talking to strangers, eating with other people, speaking at meetings) and try to answer the following questions. Your answers to these questions will give you an idea of the types of thoughts, predictions, and expectations that help to maintain your anxiety. 为了识别你自己的引发焦虑的想法，我们建议采取以下步骤。首先，回顾第 1 章中列举的一些引发焦虑的想法示例。这些示例会让你了解通常与社交焦虑相关的思维类型。接下来，想想你觉得特别困难的社交场合（例如，与陌生人交谈、与他人一起用餐、在会议上发言），并尝试回答以下问题。你对这些问题的回答将帮助你了解那些维持你焦虑的思维、预测和期望类型。
Your Anxiety-Provoking Beliefs 你的引发焦虑的信念
What am I afraid will happen in the situation? 我害怕在这种情境中会发生什么？ qquad\qquad qquad\qquad qquad\qquad
What might people think about me in the situation? 人们在这种情况下可能会怎么想我？ qquad\qquad qquad\qquad qquad\qquad
Is it almost always important that I make a good impression? Why? 我几乎总是需要给人留下好印象吗？为什么？ qquad\qquad qquad\qquad qquad\qquad
How will I react in the situation (what symptoms will I exhibit)? 我在这种情况下会如何反应（会表现出什么症状）？ qquad\qquad qquad\qquad qquad\qquad
What if my expectations come true? What might that lead to? 如果我的预期成真，会怎样？这可能导致什么？ qquad\qquad qquad\qquad qquad\qquad
Am I aware of any other beliefs or predictions that contribute to my anxiety? 我是否意识到还有其他信念或预测在加剧我的焦虑？ qquad\qquad qquad\qquad qquad\qquad qquad\qquad
WHAT ARE YOUR ANXIOUS BEHAVIORS? 你的焦虑行为有哪些？
Anxiety and fear are usually accompanied by a strong urge to do something to reduce these uncomfortable feelings. Are there behaviors that you use to reduce your anxiety? Here are some examples. 焦虑和恐惧通常伴随着强烈的冲动，想要做些什么来减轻这些不舒服的感觉。你是否有用来减轻焦虑的行为？以下是一些例子。
Avoidance of social situations. Are there situations that you refuse to enter? For example, do you avoid going to parties, particularly when you won’t know people there? When the telephone rings, do you avoid answering it? Do you turn down opportunities to do presentations even when they are important? Avoidance is one of the most common behaviors that helps to maintain your fear and anxiety. Earlier in this chapter you rated the extent to which you fear and avoid various social situations. As part of this review of your anxious behaviors, look over that list again and note which situations you tend to avoid at least some of the time. If there are any other situations that come to mind, list them below. 回避社交场合。你是否有拒绝进入的场合？例如，你是否避免参加聚会，尤其是当你不认识那里的人的时候？当电话响起时，你是否避免接听？即使是重要的场合，你是否也拒绝做演讲？回避是维持恐惧和焦虑的最常见行为之一。在本章前面，你评估了自己对各种社交场合的恐惧和回避程度。作为对你焦虑行为的回顾，请再次查看那份清单，注意你倾向于至少有时回避的场合。如果你想到其他场合，请在下面列出。
Overcompensating for perceived deficits. Are there ways in which you try extra hard in social situations to compensate for flaws or faults that you perceive yourself to have? For example, do you overprepare for presentations by putting together too much material, memorizing the presentation, or reading the presentation word for word from your notes? Do you rehearse everything that you are going to say before meeting a friend for dinner, just in case you become overly anxious and lose your train of thought? Do you go out of your way to talk a lot to appear outgoing, just so people won’t notice that you’re anxious? Each of these is an example of how people sometimes overcompensate to cover up what they perceive to be flaws. If you can think of examples of times when you have overcompensated in social situations for what you thought were flaws or faults, list them below. 对感知到的缺陷进行过度补偿。你是否在社交场合中为了弥补自己认为存在的缺点或缺陷而格外努力？例如，你是否为了演讲准备过多的材料，背诵演讲内容，或者逐字逐句地从笔记中朗读演讲稿？你是否在与朋友共进晚餐前反复排练自己要说的话，以防自己过度紧张而忘词？你是否刻意多说话以显得外向，只是为了让别人不注意到你的焦虑？这些都是人们有时为了掩盖自己认为的缺陷而过度补偿的例子。如果你能想到自己在社交场合中过度补偿以掩盖所谓缺陷的例子，请在下面列出。
Excessive checking and reassurance seeking. Social anxiety, shyness, and performance anxiety sometimes can lead people to engage in frequent checking and reassurance seeking behaviors. Examples include frequently looking in the mirror to make sure that 过度检查和寻求安慰。社交焦虑、害羞和表现焦虑有时会导致人们频繁进行检查和寻求安慰的行为。例子包括频繁照镜子以确认自己…
your hair is perfect and continually asking your friends to reassure you that you are interesting or smart. 你的头发完美无瑕，并不断地向朋友们寻求确认，确保自己有趣或聪明。
Although it is helpful to seek reassurance from time to time, constant reassurance seeking can have a negative impact by helping to maintain your fear. By asking for reassurance over and over again, you may strengthen the belief that there is something wrong with you. (Why else would you need to check so often?). Also, you run the risk of never learning to provide yourself with the reassurance that you may need. Finally, constantly asking others for reassurance may cause some of your greatest fears to come true by negatively affecting how others view you. Other people may get tired of always having to provide you with reassurance. Also, if you constantly ask others to make judgments about you (for instance, to tell you how smart, attractive, or interesting you are), you may actually be training them to be more observant and scrutinizing of you than they might otherwise be. 虽然偶尔寻求确认是有帮助的，但不断地寻求确认可能会产生负面影响，助长你的恐惧。通过一遍又一遍地请求确认，你可能会强化自己有问题的信念。（否则你为什么需要这么频繁地检查呢？）此外，你也有可能永远学不会如何自己给予所需的确认。最后，不断地向他人寻求确认可能会导致你最害怕的事情成真，负面影响他人对你的看法。别人可能会厌倦总是要给你确认。此外，如果你不断要求别人对你做出判断（例如，告诉你有多聪明、多有吸引力或多有趣），你实际上可能在训练他们比平时更细致、更挑剔地观察你。
In the space below, list some examples of times when you have engaged in excessive checking or reassurance seeking. 请在下面的空白处列举一些你曾经过度检查或寻求确认的例子。
Other subtle avoidance and safety behaviors. Overcompensating for perceived deficits and excessive checking are both examples of safety behaviors because they are used to help you feel safer in social situations. Unlike complete avoidance of feared situations, these are more subtle avoidance behaviors, and they can be more difficult to notice. Are there other subtle ways in which you avoid situations or safety behaviors that you use to protect yourself from feeling anxious in social situations? 其他微妙的回避和安全行为。为了弥补感知到的不足而过度补偿以及过度检查，都是安全行为的例子，因为它们被用来帮助你在社交场合中感到更安全。与完全回避恐惧的情境不同，这些是更微妙的回避行为，可能更难被察觉。你是否还有其他微妙的方式来回避某些情境，或者使用安全行为来保护自己免于在社交场合中感到焦虑？
For example, if you have to give a presentation, do you stand in a particular place? Do you wear certain clothes to hide “defects” that you perceive in your appearance? Do you purposely end the presentation late so that there is no time for questions? Do you use videos or slides during the presentation so the focus won’t be on you? Do you avoid making eye contact with the audience? If you’re attending a party, do you purposely stay close to someone you know well so that you won’t have to talk to other people? Do you have a drink or two as soon as you get to the party so that your anxiety doesn’t get too high? Do you offer to help in the kitchen so you won’t have to talk to the other guests? Do you take frequent bathroom breaks to avoid being with everyone else? When you’re talking to other guests at the party, do you ask the other person lots of questions to keep the focus of the conversation off of you? 例如，如果你必须做一个演讲，你会站在特定的位置吗？你会穿某些衣服来掩盖你认为自己外貌上的“缺陷”吗？你会故意把演讲时间延长，以至于没有时间提问吗？你会在演讲中使用视频或幻灯片，以便焦点不在你身上吗？你会避免与观众进行眼神交流吗？如果你参加聚会，你会故意待在一个你很熟悉的人身边，这样就不用和其他人说话吗？你一到聚会就喝一两杯，以防焦虑过高吗？你会主动去厨房帮忙，这样就不用和其他客人说话吗？你会频繁去洗手间，以避免和其他人待在一起吗？当你和聚会上的其他客人交谈时，你会问对方很多问题，以使谈话的焦点不在你身上吗？
All of these are examples of subtle avoidance strategies that people sometimes use in social situations. As discussed in chapter 1, these behaviors may decrease your anxiety in the short term by helping you to feel safer. However, in the long term, they typically have the effect of preventing your anxiety from decreasing naturally over time because 所有这些都是人们在社交场合中有时会使用的微妙回避策略的例子。如第一章所述，这些行为可能在短期内通过帮助你感觉更安全而减少你的焦虑。然而，从长远来看，它们通常会阻止你的焦虑随着时间的推移自然减少，因为
they prevent you from learning that the situation can be safe and manageable even without relying on subtle avoidance strategies. In the spaces that follow, list examples of subtle avoidance or safety behaviors that you use to manage your anxiety in social situations. Because these behaviors may differ from situation to situation, there is space to record these behaviors for up to five different social situations. 它们阻止你学习到即使不依赖微妙的回避策略，情况也可以是安全且可控的。在接下来的空白处，列出你在社交场合中用来管理焦虑的微妙回避或安全行为的例子。由于这些行为可能因情境而异，这里提供了记录多达五种不同社交情境中这些行为的空间。
Comparing yourself to the “wrong” people. One of the ways in which we evaluate ourselves is to make comparisons with other people. In school, we ask our classmates how they did on their exams to get an idea of how our own work compares to that of others. We are curious about our coworkers’ salaries, in part because having that information is a way of knowing whether we are being paid fairly. 将自己与“不合适”的人比较。我们评估自己的一种方式是与他人进行比较。在学校里，我们会问同学他们考试考得怎么样，以了解自己的成绩与他人的比较情况。我们对同事的薪水感到好奇，部分原因是掌握这些信息可以让我们知道自己是否得到了公平的报酬。
Research has consistently found that most people compare themselves to others whom they perceive to be either similar to themselves or slightly better in a particular dimension. For example, an average student is likely to compare his or her grades to those of other average students or to slightly better-than-average students. Similarly, a top athlete tends to compare his or her performance to other top athletes in order to judge the quality of his or her own performance. This pattern of social comparison makes sense because it is most likely to provide information you can use to gauge your own performance. Comparing yourself to someone whom you perceive to be much better or much worse than you in a particular dimension will provide information that isn’t especially relevant to you. For example, if you are a musician who plays mostly in local clubs, it doesn’t make sense to compare your success to that of the most popular and successful musicians in the world. Making such comparisons is likely to cause you to feel inadequate because you will perceive that you can’t possibly compete with the best. 研究一贯发现，大多数人会将自己与那些他们认为在某一方面与自己相似或稍微优于自己的人进行比较。例如，一个普通学生很可能会将自己的成绩与其他普通学生或稍微优于平均水平的学生进行比较。同样，一名顶尖运动员倾向于将自己的表现与其他顶尖运动员进行比较，以评估自己表现的质量。这种社会比较的模式是合理的，因为它最有可能提供你用来衡量自己表现的信息。将自己与在某一方面被你认为远远优于或远远不如你的人进行比较，所获得的信息对你来说并不特别相关。例如，如果你是一名主要在本地俱乐部演出的音乐家，将自己的成功与世界上最受欢迎和最成功的音乐家进行比较是没有意义的。进行这样的比较很可能会让你感到不足，因为你会觉得自己根本无法与最优秀的人竞争。
Research from our center (Antony et al. 2005) suggests that people who are socially anxious make different types of social comparisons than do those who are less anxious. Specifically, social anxiety is associated with a tendency to make more frequent “upward” comparisons. In other words, people who are socially anxious are more likely to compare themselves to people they perceive as better than they are. The tendency to make upward comparisons increases the likelihood that an individual will feel worse after making the comparison. 我们中心的研究（Antony 等，2005）表明，社交焦虑者进行的社交比较类型与焦虑较轻的人不同。具体来说，社交焦虑与更频繁地进行“向上”比较的倾向有关。换句话说，社交焦虑者更可能将自己与他们认为比自己更优秀的人进行比较。进行向上比较的倾向增加了个体在比较后感到更糟的可能性。
Can you think of recent examples of when you have compared yourself to someone whom you perceived to be more attractive, more competent, less anxious, stronger, or smarter than you are? Or, did you make an upward comparison on some other dimension? How did you feel afterward? Do you often tend to compare yourself to people whom you perceive to be ideal or perfect on a certain dimension, rather than people whom you perceive to be typical or average? In the space below, describe an example of a time when you compared yourself to someone who was much “better” than you in some way. 你能想到最近有没有将自己与某个你认为比你更有吸引力、更有能力、更少焦虑、更坚强或更聪明的人进行比较的例子吗？或者，你是否在其他某个方面进行了向上比较？之后你的感受如何？你是否经常倾向于将自己与某个你认为在某方面理想或完美的人进行比较，而不是与那些你认为是典型或普通的人比较？请在下面的空白处描述一个你曾经将自己与某个在某方面远远“优于”你的人进行比较的例子。
COULD YOU BENEFIT FROM IMPROVING YOUR "PEOPLE SKILLS"? 你是否可以通过提升你的“人际交往技巧”而受益？
Everyone has times when they give off the wrong impression simply because they didn’t know how to communicate a particular message to another person or group. Generally, this is not a big problem unless it happens frequently or in situations where there is a lot at stake. 每个人都有过因为不知道如何向另一个人或群体传达特定信息而给人留下错误印象的时候。通常，这不是大问题，除非这种情况频繁发生或发生在利害关系重大的场合。
In most cases, people who are socially anxious have fine social skills, though they tend to assume that their social skills are much worse than they actually are. Furthermore, as their anxiety decreases and they obtain more practice interacting with others in the situations that they fear, their skills tend to improve over time. Following are some examples of areas where you may want to consider working on improving your skills. This may prove to be particularly helpful for situations that you have tended to avoid over the years and therefore may not have had the opportunity to learn some of the subtleties of navigating your way through the situation. For example, if you have never dated, you may need some practice before knowing how to ask someone out on a date to maximize your chances of a positive response. As you read through the examples, try to identify people skills that you may want to work on. There is space at the end of this section to record your responses. 在大多数情况下，社交焦虑的人具备良好的社交技能，尽管他们往往认为自己的社交技能远比实际情况差。此外，随着焦虑的减轻以及在他们害怕的情境中与他人互动的练习增多，他们的技能通常会随着时间的推移而提高。以下是一些你可能想要考虑提升技能的领域示例。这对于那些你多年来倾向于回避的情境尤其有帮助，因为你可能没有机会学习如何巧妙应对这些情境的细节。例如，如果你从未约会过，可能需要一些练习，才能知道如何邀请某人约会，以最大化获得积极回应的机会。在阅读这些示例时，试着找出你可能想要提升的人际交往技能。本节末尾有空白处供你记录你的回答。
Assertiveness. Do you have difficulty being assertive? In other words, is it hard for you to say no if someone asks you to do something that you don’t want to do? Is it difficult to ask people to change their behavior if they are treating you unfairly or aren’t doing 自信表达。你是否难以自信表达自己？换句话说，当有人让你做你不想做的事情时，你是否很难说“不”？如果别人对你不公平或行为不当，你是否难以要求他们改变？
their share of the work? Most people sometimes find it difficult to deal directly and assertively with situations like these. However, the more difficulty that you have in situations that call for assertive communication, the more you have to gain from learning assertiveness skills. 他们分担了应做的工作吗？大多数人有时会发现直接且坚定地处理这类情况很困难。然而，你在需要坚定沟通的情境中遇到的困难越多，你从学习坚定沟通技巧中获得的益处也就越大。
Body language, tone of voice, and eye contact. Do you have difficulty making eye contact with other people? Does your tone of voice or body language send the message that you are not open to interacting with others? Behaviors that convey such messages may include speaking very quietly or letting your voice drop off at the end of your sentences, standing far away from other people when you’re talking with them, answering questions with very short responses, and displaying a “closed” body posture (such as crossing your arms and legs). Although you may use these behaviors to protect yourself in social situations, they may actually have the opposite effect by turning others away. If you send the message to others that you are unavailable, they will be more likely to leave you alone. 肢体语言、语调和眼神交流。你是否难以与他人进行眼神交流？你的语调或肢体语言是否传达出你不愿与他人互动的信息？传达这种信息的行为可能包括说话声音非常轻柔，或者句尾声音逐渐降低，与他人交谈时站得很远，用非常简短的回答回应问题，以及表现出“封闭”的身体姿势（例如交叉双臂和双腿）。虽然你可能通过这些行为来保护自己免受社交场合的困扰，但实际上它们可能产生相反的效果，使他人远离你。如果你向他人传递出你不愿接触的信号，他们更可能选择不打扰你。
Conversation skills. Do you have difficulty knowing what to say when talking to people at work or school? Is it hard to know how or when to end conversations? Do you find it difficult to know where the fine line is between appropriate self-disclosure and talking too much about yourself? Do you often offend other people with comments that you make? If you have difficulty making small talk or engaging in casual conversations, you may benefit by working on improving these skills. 交谈技巧。你是否在与工作或学校的人交谈时不知道该说什么？你是否难以判断如何或何时结束对话？你是否觉得难以把握适当自我披露和过多谈论自己的界限？你是否经常因为自己的言论冒犯他人？如果你在进行闲聊或随意交谈时感到困难，提升这些技能可能会对你有所帮助。
Meeting new people. Do you have difficulty knowing what to say when you want to initiate contact with new people? Do you have difficulty asking someone out on a date? Are you at a loss for knowing how and where to meet new people? There are lots of different places to meet new people and lots of tricks to making meeting people easier. The first step is identifying whether this is an area that you would like to work on. 结识新朋友。你是否在想要与新朋友建立联系时不知道该说什么？你是否难以约人出去约会？你是否不知道如何以及在哪里结识新朋友？有很多不同的地方可以结识新朋友，也有许多让结识新朋友变得更容易的技巧。第一步是确定这是否是你想要努力改进的领域。
Presentation skills. Speaking effectively in public involves a number of complex skills and behaviors. It’s not enough to be calm and confident. An effective speaker also knows how to maintain the audience’s interest by using humor and effective audiovisual aids and handouts, stimulating audience participation, and conveying an interest in the topic. If you fear making presentations, part of overcoming your fear may include improving your speaking skills. 演讲技巧。有效的公众演讲涉及许多复杂的技能和行为。仅仅保持冷静和自信是不够的。一位有效的演讲者还知道如何通过幽默、有效的视听辅助工具和讲义来保持观众的兴趣，激发观众参与，并传达对主题的兴趣。如果你害怕做演讲，克服恐惧的一部分可能包括提升你的演讲技巧。
In the space below, list any social or communication skills that you might like to improve. 在下面的空白处，列出你希望改进的任何社交或沟通技能。
Social Skills That I Would Like to Develop or Improve 我希望发展或改进的社交技能
HOW MUCH DOES YOUR SOCIAL ANXIETY BOTHER YOU OR INTERFERE WITH YOUR LIFE? 你的社交焦虑在多大程度上困扰你或干扰你的生活？
As we discussed in chapter 1, social anxiety, shyness, and performance-related fears are only a problem if they interfere with aspects of your functioning or if having the fear is troublesome for you. So, as part of your self-assessment, it’s important for you to determine which aspects of your fear trouble you and which don’t. Are there particular situations for which you are most interested in overcoming your fear? For example, it may be important for you to overcome your fear of socializing with friends but relatively less important for you to overcome your fear of speaking in front of large groups if that situation never arises. 正如我们在第一章中讨论的，社交焦虑、害羞和与表现相关的恐惧只有在它们干扰你的功能或让你感到困扰时才是问题。因此，作为自我评估的一部分，确定哪些方面的恐惧让你感到困扰，哪些方面则没有，这一点非常重要。是否有某些特定情境是你最想克服恐惧的？例如，克服与朋友社交的恐惧可能对你很重要，但如果你从未遇到过在大群体面前演讲的情况，那么克服这种恐惧可能相对不那么重要。
In the space below, record (1) the ways in which your social anxiety interferes with your functioning (including work or school, social life, relationships, hobbies and leisure activities, home and family life), (2) the specific aspects of your social anxiety that you most want to change, and (3) any aspects of your social anxiety that you are not interested in working on. 请在下面的空白处记录（1）你的社交焦虑如何干扰你的功能（包括工作或学校、社交生活、人际关系、爱好和休闲活动、家庭生活），（2）你最想改变的社交焦虑的具体方面，以及（3）你不想处理的社交焦虑的任何方面。
Ways in Which Social Anxiety Interferes with My Life 社交焦虑干扰我生活的方式
Aspects of My Social Anxiety That I Want to Change 我想改变的社交焦虑方面
Aspects of My Social Anxiety That I Don't Want to Change 我不想改变的社交焦虑方面
HOW AND WHEN DID YOUR SOCIAL ANXIETY BEGIN? 你的社交焦虑是如何以及何时开始的？
How old were you when you first had significant anxiety in social situations? What was going on at that time in your life? 你第一次在社交场合感到明显焦虑时几岁？那时你生活中发生了什么事情？
How old were you when you first noticed that your social anxiety began to interfere with aspects of your life? What was going on at the time? 你第一次注意到社交焦虑开始干扰你生活的某些方面时几岁？那时发生了什么？
What has the course of your social anxiety been over the years? Has it improved, stayed the same, or worsened? Are you aware of factors that may have caused it to change over the years (for example, getting married or moving to a new neighborhood)? 多年来你的社交焦虑状况如何？是有所改善、保持不变，还是加重了？你是否意识到有哪些因素可能导致它多年来发生变化（例如结婚或搬到新社区）？
Are there specific events that initially caused you to become more nervous in social situations or made your social anxiety worsen? (Examples may include experiences such as presentations that didn’t go well, being teased while growing up, or doing something embarrassing or humiliating in public.) 有没有具体的事件最初让你在社交场合变得更加紧张，或者使你的社交焦虑加重？（例如，演讲不顺利、成长过程中被取笑，或在公共场合做了令人尴尬或羞辱的事情。）
DOES ANYONE ELSE IN YOUR FAMILY HAVE THIS PROBLEM? 你的家里还有其他人有这个问题吗？
Are you aware of anyone else in your family having problems with shyness, social anxiety, or performance-related fears? If so, do you think that this had an influence on how you feel in these situations? If yes, how? 你是否知道家里其他人有害羞、社交焦虑或与表现相关的恐惧问题？如果有，你认为这对你在这些情境中的感受有影响吗？如果有，是怎样的影响？
ARE THERE ANY PHYSICAL CONDITIONS THAT CONTRIBUTE TO YOUR SOCIAL ANXIETY? 有没有任何身体状况会加重你的社交焦虑？
For some individuals, certain physical or medical conditions may influence their tendency to experience social anxiety. For example, people who stutter may be more nervous when talking to others compared with people who don’t stutter. Often, their fear is exclusively related to a concern that they will stutter and that others will notice. Similarly, people suffering from other medical conditions (for example, shaking due to Parkinson’s disease, having to move about in a wheelchair, not being able to write neatly due to severe arthritis) may be self-conscious about having others observe their symptoms. 对于某些人来说，某些身体或医疗状况可能会影响他们体验社交焦虑的倾向。例如，口吃的人在与他人交谈时可能比不口吃的人更紧张。他们的恐惧通常仅仅与担心自己会口吃以及别人会注意到这一点有关。类似地，患有其他医疗状况的人（例如，因帕金森病导致的颤抖、需要使用轮椅行动、因严重关节炎无法写字工整）可能会因为害怕别人注意到他们的症状而感到不自在。
Other people, although they may not be suffering from a medical condition, may still have a greater tendency than others to have shaky hands, blush easily, or sweat excessively, independent of their fears. For these individuals, these reactions tend to be very intense and may often occur even outside of social situations and when they are not particularly anxious. Although many people who experience these symptoms at such an extreme level are not concerned about others noticing, for some, having these extreme symptoms contributes to their social anxiety. 其他人，尽管他们可能没有患有医学疾病，但仍可能比其他人更容易出现手抖、脸红或出汗过多的情况，这些反应与他们的恐惧无关。对于这些人来说，这些反应往往非常强烈，甚至常常发生在社交场合之外，且当时他们并不特别焦虑。虽然许多经历这些极端症状的人并不在意别人是否注意到，但对一些人来说，出现这些极端症状会加重他们的社交焦虑。
Do you suffer from any physical conditions or medical illnesses that add to your anxiety around other people? If so, record the details below. 你是否患有任何身体状况或医学疾病，导致你在他人面前感到更加焦虑？如果有，请在下面记录详细情况。
DIARIES 日记
The diaries used to assess social anxiety are usually forms on which individuals record their anxiety-related symptoms, including frequency of exposure to feared situations, 用于评估社交焦虑的日记通常是表格，个人在上面记录与焦虑相关的症状，包括暴露于恐惧情境的频率，
anxiety levels (using a numeric scale such as 0 through 100), uncomfortable physical sensations such as blushing or shaking, anxious thoughts and predictions (for instance, “I will make a fool of myself during this presentation”), and anxious behaviors such as avoidance and distraction. An example of such a diary is the Three Components of Social Anxiety Monitoring Form, which you completed in chapter 1. Numerous other forms and diaries are included throughout this book as well. They are designed to be used while you try the specific treatment techniques described in later chapters. 焦虑水平（使用 0 到 100 的数字量表）、不适的身体感觉如脸红或颤抖、焦虑的想法和预测（例如，“我在这次演讲中会出丑”），以及焦虑的行为如回避和分心。此类日记的一个例子是你在第一章完成的社交焦虑三要素监测表。本书中还包含了许多其他表格和日记。它们设计用于你尝试后续章节中描述的具体治疗技巧时使用。
BEHAVIORAL ASSESSMENTS 行为评估
The most commonly used type of behavioral assessment for social anxiety is the Behavioral Approach Test, or BAT. This assessment method involves physically entering a feared situation and measuring your anxiety and associated symptoms. For example, if you are afraid of public speaking, you might force yourself to speak at a staff meeting. After the meeting, you can record the particulars of the situation (who else was there, how long you spoke for, and so on), your fear level (for example, 80 out of 100), your anxious thoughts (such as, “My words will come out all jumbled”), and whether you engaged in any avoidance behaviors (like avoiding eye contact). 社交焦虑最常用的行为评估类型是行为接近测试，简称 BAT。这种评估方法涉及实际进入一个令你害怕的情境，并测量你的焦虑及相关症状。例如，如果你害怕公开演讲，你可能会强迫自己在员工会议上发言。会议结束后，你可以记录情境的具体情况（例如，现场还有谁，你发言了多长时间等）、你的恐惧程度（例如，100 分中 80 分）、你的焦虑想法（比如，“我的话会说得乱七八糟”），以及你是否采取了任何回避行为（如避免眼神接触）。
If it is too frightening to try this in a real-life situation, or if it is impossible to do so for another reason, the assessment can be completed in the form of a role-play. In a role-play, the person acts out the feared situation with the therapist or another individual present, instead of being in the real situation. For example, if you are afraid of job interviews, you might try to practice a job interview with another person (friend, family member, or therapist) taking the role of the interviewer. Following the practice, you would again record the particulars of the situation, your fear level, your anxious thoughts, and your avoidance behaviors. 如果在现实生活中尝试这样做太令人害怕，或者由于其他原因无法做到，可以通过角色扮演的形式完成评估。在角色扮演中，个体与治疗师或其他人在场的情况下，扮演出害怕的情境，而不是身处真实情境中。例如，如果你害怕面试，可以尝试与另一人（朋友、家人或治疗师）练习面试，由对方扮演面试官的角色。练习结束后，你需要再次记录情境的具体情况、你的恐惧程度、焦虑的想法以及回避行为。
Therapists use behavioral assessments because they have several advantages over traditional forms of assessment, such as interviews and questionnaires. First, they are less likely to be influenced by people’s difficulties in remembering the details of their fears. For example, some people may overestimate or underestimate their fear levels if they are asked to describe their fear during past exposures to feared situations. Their memories may be influenced by a particularly negative experience in a feared situation and, as a result, they may report that their fear is actually higher than it typically is. Also, people’s memories regarding their reactions in the situations they fear may be poor simply because they typically avoid the fearful situation, making it difficult to know for sure how they feel when they are exposed to the situation. 治疗师使用行为评估是因为它们相比传统的评估形式（如访谈和问卷）具有若干优势。首先，它们不太可能受到人们记忆恐惧细节困难的影响。例如，如果让一些人描述他们在过去面对恐惧情境时的恐惧程度，他们可能会高估或低估自己的恐惧水平。他们的记忆可能会受到某次特别负面的恐惧经历的影响，因此他们可能报告的恐惧实际上比平时更强烈。此外，人们对自己在恐惧情境中的反应记忆可能较差，原因仅仅是他们通常会避免这些恐惧情境，这使得很难确切知道他们在暴露于该情境时的真实感受。
Another advantage of the behavioral approach test is that it allows the therapist and the individual to directly observe anxious thoughts and behaviors that might otherwise go unnoticed. It also allows the therapist to independently assess the extent to which the client’s shaking, blushing, or sweating is actually noticeable to others. 行为评估的另一个优势是，它允许治疗师和个体直接观察那些可能被忽视的焦虑思维和行为。它还使治疗师能够独立评估客户的颤抖、脸红或出汗在他人眼中实际有多明显。
Can you think of a behavioral approach test or role-play that you can set up for yourself? For example, if you are fearful of speaking up in a meeting, try doing it anyway. Immediately after the meeting, record your physical symptoms, anxious thoughts, and the avoidance behaviors that took place while you were conducting the practice. Did it go better than you expected it to go? Was it worse? Was it about what you expected? 你能想到一个可以自己设定的行为测试或角色扮演吗？例如，如果你害怕在会议上发言，试着去做。会议结束后，立即记录你的身体症状、焦虑的想法以及在练习过程中出现的回避行为。结果比你预期的要好还是更糟？还是和你预期的一样？
TROUBLESHOOTING 故障排除
You may find that your self-assessment does not go as smoothly as you might like. Here are some common problems that may arise during your self-assessment, as well as some solutions, suggestions, and words of reassurance. 你可能会发现自我评估并不像你希望的那样顺利。以下是自我评估过程中可能出现的一些常见问题，以及一些解决方案、建议和安慰的话语。
Problem: I didn’t know the answers to all the questions. 问题：我不知道所有问题的答案。
Solution: That’s to be expected. As you progress with the treatment, you will have an opportunity to become better acquainted with your social anxiety. Self-assessment is an ongoing process, and it’s not necessary to have all the answers before you start to work on changing your social anxiety. In fact, there may be some questions that you will never know the answers to, and that’s okay. The purpose of this chapter is just to help you better understand the areas that are causing you the most difficulty. 解决方案：这是意料之中的。随着治疗的进展，你将有机会更好地了解你的社交焦虑。自我评估是一个持续的过程，在开始改变社交焦虑之前，不必拥有所有答案。事实上，有些问题你可能永远无法找到答案，这也没关系。本章的目的是帮助你更好地理解那些给你带来最大困难的方面。
Problem: Answering these questions increased my anxiety. 问题：回答这些问题让我焦虑加剧。
Solution: This is quite common. Conducting a self-assessment forces you to pay attention to the thoughts that contribute to your anxiety. This effect of increased anxiety tends to be temporary. As you progress through the treatment procedures discussed throughout this book, it is likely you will find that focusing on the thoughts and feelings associated with your social anxiety will become less anxiety provoking. 解决方案：这是很常见的。进行自我评估会迫使你关注那些导致焦虑的想法。这种焦虑增加的效果通常是暂时的。随着你按照本书中讨论的治疗程序逐步进行，你可能会发现，关注与你的社交焦虑相关的想法和感受会变得不那么令人焦虑。
Problem: My answers to these questions depend on many different variables, so I find it difficult to come up with a response to certain questions. 问题：我对这些问题的回答取决于许多不同的变量，所以我发现很难对某些问题给出回应。
Solution: This concern is often raised by people who are undergoing an assessment. Questions are often difficult to answer because the responses depend on so many different factors. For example, the question, “How fearful are you of public speaking?” may depend on such things as the topic of the presentation, the number of people in the audience, the lighting in the room, the length of the presentation, how prepared you are, and many other factors. We suggest that you handle difficult questions by estimating your response based on a typical or average situation. So, if your fear of public speaking ranges from 30 to 70 depending on the situation, you could put down 50. If you prefer, you could just record the range " 30 to 70 " which would be more precise. 解决方案：这个问题通常是正在接受评估的人提出的。问题往往难以回答，因为回答取决于许多不同的因素。例如，“你对公开演讲的恐惧程度有多大？”这个问题可能取决于演讲的主题、观众人数、房间的照明、演讲的时长、你的准备情况以及许多其他因素。我们建议你通过基于典型或平均情况来估计你的回答，从而处理难以回答的问题。因此，如果你对公开演讲的恐惧程度根据情况在 30 到 70 之间波动，你可以填写 50。如果你愿意，也可以直接记录“30 到 70”的范围，这样会更准确。
After reading this chapter, you should have a better understanding of the nature of your social anxiety. You should be more aware of the types of social situations that you fear and avoid, the variables that affect your discomfort level, the physical sensations that you experience when you are anxious, the thoughts and behaviors that contribute to your fear, and the ways in which social anxiety interferes with your life. Understanding these aspects of your social anxiety will help you to choose the best strategies for overcoming your fear as you work your way through the rest of this book. 阅读本章后，你应该对自己的社交焦虑的本质有更深入的了解。你会更加清楚自己害怕和回避的社交场合类型，影响你不适感的各种因素，焦虑时所体验到的身体感觉，助长你恐惧的思维和行为，以及社交焦虑如何干扰你的生活。理解这些社交焦虑的方面将帮助你在阅读本书剩余内容时，选择克服恐惧的最佳策略。
PART 2 第二部分
How to Overcome Social Anxiety and Enjoy Your Life 如何克服社交焦虑，享受生活
CHAPTER 4 第四章
Making a Plan for Change 制定变革计划
This chapter will help you to consider the range of factors that are important for developing a treatment plan. These factors include deciding whether this is the best time for you to work on your social anxiety, addressing the issue of motivation and readiness for change, selecting treatment goals, trying to understand why treatment may or may not have worked in the past, and understanding your current options for treatment. 本章将帮助你考虑制定治疗计划时需要关注的各种因素。这些因素包括决定现在是否是你处理社交焦虑的最佳时机，解决动机和准备改变的问题，选择治疗目标，尝试理解过去治疗为何可能有效或无效，以及了解你当前的治疗选择。
IS NOW THE BEST TIME TO START THIS PROGRAM? 现在是开始这个项目的最佳时机吗？
In some ways, it may seem as if there is never a good time to begin a new project. There are almost always competing demands that make it difficult to find free time or extra energy to start something new. Work may be unusually busy, you may be getting over a cold, or your children may be a handful right now. Although the time may not be perfect, you will need to decide whether it is even a possibility for you to start this program given your current life circumstances. Your chances of getting the most out of this book will depend on your answering yes to the following questions: 在某种程度上，似乎永远没有合适的时间开始一个新项目。几乎总有各种竞争性的需求，使得很难找到空闲时间或额外精力去开始新的事情。工作可能异常繁忙，你可能刚刚感冒好转，或者你的孩子现在特别难管。虽然时间可能不完美，但你需要决定在你当前的生活状况下，是否有可能开始这个项目。你能否最大限度地利用这本书，取决于你是否能对以下问题回答“是”：
Are you motivated to become less shy or to decrease your social anxiety? Is this something you really care about? 你是否有动力变得不那么害羞，或者减少你的社交焦虑？这真的是你关心的事情吗？
Are you willing to feel even more anxious in the short term in order to feel more comfortable in social and performance situations in the future? 你是否愿意在短期内感到更加焦虑，以便将来在社交和表现场合中感到更自在？
Are you able to put aside, at least to some extent, other major problems and stresses in your life (things such as family problems or work stresses) so that you can focus on learning to manage your social and performance anxiety? 你是否能够至少在一定程度上放下生活中的其他重大问题和压力（例如家庭问题或工作压力），以便专注于学习管理你的社交和表现焦虑？
Are you able to set aside several blocks of time several days per week to practice the techniques described in this book? 你是否能够每周抽出几天的几个时间段来练习本书中描述的技巧？
Hopefully, after carefully considering these questions, you will make a commitment to work on overcoming your social anxiety. However, you may also decide that this is not the best time for you to work on the problem and that you would rather wait until your life situation changes. If that is the case, you may still find reading this book helpful because it contains strategies that can be used from time to time, as you need them. However, making big changes will require using the techniques described in this book frequently and consistently. The next section will help you further as you decide whether to work on your anxiety at this time. 希望在仔细考虑这些问题后，你能够下定决心，努力克服社交焦虑。然而，你也可能会决定现在不是解决这个问题的最佳时机，而是选择等待生活状况发生变化。如果是这样，你仍然可能觉得阅读本书有帮助，因为书中包含了一些可以根据需要不时使用的策略。不过，要实现重大改变，就需要频繁且持续地运用本书中描述的技巧。下一部分将进一步帮助你决定是否在此时着手解决你的焦虑问题。
MOTIVATION AND READINESS FOR CHANGE 动机与改变准备度
Experts have identified five stages that people go through as they contemplate making a change in behavior, such as quitting smoking, losing weight, or improving their work habits (Prochaska, DiClemente, and Norcross 1992). The model describing these stages of change is often referred to as the transtheoretical model of change. These five stages include: 专家们发现，人们在考虑改变行为时（如戒烟、减肥或改善工作习惯）会经历五个阶段（Prochaska、DiClemente 和 Norcross，1992）。描述这些变化阶段的模型通常被称为跨理论变化模型。这五个阶段包括：
Precontemplation. At this stage, people are unaware that they have a problem or they have no intention of changing, either because they are unwilling to change or they are convinced that change is impossible. An example would be someone who is very overweight and is convinced that nothing can be done about it. (So why bother trying?) 未准备阶段。在这个阶段，人们没有意识到自己有问题，或者没有改变的意图，可能是因为他们不愿意改变，或者坚信改变是不可能的。举例来说，有些体重严重超标的人坚信无论做什么都无法改变现状。（那为什么还要尝试呢？）
Contemplation. At this stage, the individual intends to change sometime soon (for example, in the next six months). The person is aware of the benefits of changing but is also still focused on the possible costs. An example is a smoker who’s thinking about quitting in a few months. 考虑阶段。在这个阶段，个体打算在不久的将来改变（例如，在接下来的六个月内）。此时，个人意识到改变的好处，但仍然关注可能的代价。举例来说，有吸烟习惯的人正在考虑几个月后戒烟。
Preparation. At this stage, the person is ready to change in the near future (for example, in the next month). The benefits of change are much more obvious to the person than the costs of changing. An example is someone who has decided to join a gym in a couple of weeks to become more fit. 准备阶段。在这个阶段，个人准备在近期内改变（例如，在接下来的一个月内）。此时，改变的好处对个人来说比改变的代价更明显。举例来说，有人决定在几周后加入健身房以增强体质。
Action. At this stage, the individual actually takes steps to change a problem behavior. For example, an individual who feels depressed might start to see a therapist for depression. 行动阶段。在这个阶段，个体实际采取措施改变问题行为。例如，感到抑郁的人可能开始寻求治疗抑郁的心理医生。
Maintenance. At this stage, the individual has made the change and is taking steps to prevent the problem behavior from returning. An example would be an individual with a history of problem drinking who has now been sober for six months and has stopped spending time with people who drink excessive amounts of alcohol. 维持阶段。在这个阶段，个体已经做出了改变，并采取措施防止问题行为的复发。举例来说，一个有酗酒史的人现在已经戒酒六个月，并且停止与那些大量饮酒的人交往。
Although this model has been studied mostly in people who are working on changing health habits (for example, exercise, diet, substance abuse, improving medication compliance), it can also be applied to your treatment for shyness and social anxiety. The further along you are with respect to these stages of change, the more likely you will be to benefit from the strategies described in this book. For example, if you are in the action stage, you will likely get more out of this book than if you are at the precontemplation stage and have no intention of making any changes. 虽然这一模型主要是在致力于改变健康习惯的人群中进行研究的（例如锻炼、饮食、物质滥用、改善用药依从性），但它同样适用于你对害羞和社交焦虑的治疗。你在这些变化阶段中走得越远，就越有可能从本书中描述的策略中受益。例如，如果你处于行动阶段，你很可能比处于无意改变的前沉思阶段时从本书中获得更多帮助。
Of course, these stages overlap with one another, and deciding which stage you are in is not always so clean cut. In fact, you may be at a different stage for different aspects of your social anxiety. You may be convinced that it is completely impossible that you will ever be able to date (precontemplation), but you may be thinking about working on finding a better job over the next few months (contemplation). You may also have already signed up for a night class so you can start to meet new friends (action). Fortunately, as you make changes in some areas, you may discover that you become more ready to make changes in other areas as well. 当然，这些阶段彼此重叠，确定自己处于哪个阶段并不总是那么明确。事实上，你在社交焦虑的不同方面可能处于不同的阶段。你可能坚信自己永远不可能约会（前沉思阶段），但你可能正在考虑在接下来的几个月里努力找到一份更好的工作（沉思阶段）。你也可能已经报名参加了夜校课程，以便开始结识新朋友（行动阶段）。幸运的是，当你在某些方面做出改变时，你可能会发现自己也更准备在其他方面做出改变。
Success at changing your social anxiety will require that you are willing, able, and ready to take action (Miller and Rollnick 2002). Being willing means that the change is important to you, and that this is a change you want to make. Being able means that you are confident in your ability to make the change (once you have been given the right tools and strategies). Being ready means that this is a high priority for you, and that you are prepared to put other priorities aside for now in order to get this done. Use the scale below to rate the extent to which you are willing, able, and ready to make this change. For each rating, you may use any number from 0 to 100 . 成功改变你的社交焦虑需要你愿意、有能力并且准备好采取行动（Miller 和 Rollnick 2002）。愿意意味着这个改变对你很重要，并且这是你想要做出的改变。有能力意味着你对自己能够做出改变有信心（在获得了正确的工具和策略之后）。准备好意味着这是你的高优先事项，并且你准备暂时放下其他优先事项来完成这件事。使用下面的量表来评估你愿意、有能力和准备好做出这一改变的程度。每个评分可以使用 0 到 100 之间的任意数字。
qquad\qquad Willing (rate from 0 to 100) qquad\qquad 愿意（评分从 0 到 100） qquad\qquad Able (rate from 0 to 100) qquad\qquad 能力（评分范围 0 到 100） qquad\qquad Ready (rate from 0 to 100) qquad\qquad 准备度（评分范围 0 到 100）
COSTS AND BENEFITS OF OVERCOMING YOUR ANXIETY 克服焦虑的成本与收益
For the majority of people, the benefits of using the strategies described in this book will far outweigh the costs. If you didn’t believe that, you probably wouldn’t be reading this book. Still, you may have mixed feelings about changing, and therefore it may be helpful to think about your reasons for change, as well as your reasons for not changing. We will start with a discussion of the potential costs of change. 对于大多数人来说，使用本书中描述的策略所带来的收益远远超过成本。如果你不这么认为，你可能也不会读这本书。不过，你可能对改变抱有复杂的感情，因此思考你改变的理由以及不改变的理由可能会有所帮助。我们将从讨论改变的潜在成本开始。
Costs of Overcoming Your Social Anxiety 克服社交焦虑的代价
In this section, we discuss the costs of changing. As you go through this section, notice that these potential costs are mostly short-term inconveniences that are only present while you are actively working on your anxiety. As your anxiety improves, these costs will fade as well. Also, instead of thinking about these as costs, it is helpful to think of them as challenges. After all, most of these costs are manageable, and there are often possible solutions available to minimize their impact. 在本节中，我们将讨论改变的代价。在阅读本节内容时，请注意这些潜在的代价大多是短期的不便，只在你积极应对焦虑的过程中存在。随着你的焦虑改善，这些代价也会逐渐消失。此外，与其将这些视为代价，不如把它们看作挑战。毕竟，这些代价大多是可以应对的，通常也有可能的解决方案来减少它们的影响。
Costs of medication treatments. If you choose to use medications, you will have to remember to take them regularly, and newer medications may be expensive, particularly if they are not covered by your health plan. You may experience side effects. Depending on the medication, side effects may include fatigue, headaches, changes in weight and appetite, and changes in sexual functioning. Of course, as you will learn in chapter 5, many of the side effects associated with medications are worst in the first few weeks, improve over time, and are generally quite manageable. Side effects can also be minimized by adjusting doses, changing medications, or stopping medications altogether. 药物治疗的费用。如果你选择使用药物治疗，你需要记得定期服用，而且新型药物可能价格较高，尤其是在你的健康保险不覆盖的情况下。你可能会经历副作用。根据不同的药物，副作用可能包括疲劳、头痛、体重和食欲的变化，以及性功能的变化。当然，正如你将在第 5 章中了解到的，许多药物相关的副作用在最初几周最为严重，随着时间推移会有所改善，且通常是可以很好控制的。通过调整剂量、更换药物或完全停止用药，也可以减少副作用。
Costs of psychological treatments. Psychological treatments, such as confronting the situations that you fear, are also associated with costs. First, they are time-consuming. To get the most out of exposure-based treatments, for example, you may need to practice for an hour or more, three to five days per week. Also, psychological treatments can be expensive (especially in the short term), depending on your insurance coverage and the fees charged by the therapist. In addition, conducting exposure practices will probably make you feel anxious and uncomfortable, particularly at the start. Although the exercises are designed so that the discomfort is usually manageable, at times your fear may be intense. In addition to feeling uncomfortable, you may feel more tired, especially on days when you practice confronting situations that make you uncomfortable. You also may feel irritable and perhaps even have anxiety-provoking dreams. Finally, your improvement may not follow a smooth course. It is likely the changes will take time and you may have periods (days, weeks, or even months) during which you feel as though you’re slipping backward. For many people this is a normal part of the process 心理治疗的成本。心理治疗，例如面对你害怕的情境，也伴随着一定的成本。首先，它们耗时较长。例如，为了最大限度地利用基于暴露的治疗，你可能需要每周练习三到五天，每次一小时或更长时间。此外，心理治疗可能费用较高（尤其是在短期内），这取决于你的保险覆盖范围和治疗师收取的费用。此外，进行暴露练习可能会让你感到焦虑和不适，尤其是在开始阶段。虽然这些练习的设计通常使不适感在可控范围内，但有时你的恐惧可能会非常强烈。除了感到不适外，你可能会感到更加疲惫，特别是在练习面对让你不舒服的情境的日子里。你也可能感到易怒，甚至可能做一些引发焦虑的梦。最后，你的改善过程可能不会一帆风顺。变化可能需要时间，你可能会经历一些时期（几天、几周甚至几个月），感觉自己在倒退。 对于许多人来说，这是克服社交焦虑过程中的正常部分
of overcoming social anxiety. By continuing to use the strategies described in this book, however, your anxiety should continue to improve over time. 然而，通过继续使用本书中描述的策略，你的焦虑应该会随着时间的推移持续改善。
Other possible costs of improving. Overcoming your anxiety may also have an impact on other areas of your life. In most cases, the impact will be positive, but there may be some costs associated with these changes as well. If you are in a long-term relationship, you might find that your partner will need time to adjust to the changes you are making. For example, as you become more comfortable socializing, you may be out more often with friends or coworkers. If your partner is accustomed to having you around most of the time, these changes may require some getting used to. It may be helpful to discuss the changes that you are making openly with your partner, friends, and family members, if appropriate. This will demonstrate to them that you are sensitive to how the improvements in your social anxiety may affect them. 改善可能带来的其他代价。克服焦虑也可能影响你生活的其他方面。在大多数情况下，这种影响是积极的，但这些变化也可能带来一些代价。如果你处于一段长期关系中，你可能会发现你的伴侣需要时间来适应你所做的改变。例如，随着你变得更自在地社交，你可能会更频繁地与朋友或同事外出。如果你的伴侣习惯了你大部分时间都在身边，这些变化可能需要一些时间来适应。与你的伴侣、朋友和家人（如果合适的话）公开讨论你所做的改变可能会有所帮助。这将向他们表明，你对社交焦虑改善可能对他们产生的影响持敏感态度。
Can you think of other possible costs of overcoming your social anxiety, shyness, or performance-related fears? If so, record them in the following space. 你能想到克服社交焦虑、害羞或与表现相关的恐惧可能带来的其他代价吗？如果能，请在以下空白处记录下来。
Benefits of Overcoming Your Social Anxiety 克服社交焦虑的好处
Fortunately, there are also benefits of overcoming your social anxiety. As we mentioned in the last section, the costs of overcoming your anxiety are usually just shortterm inconveniences. On the other hand, the benefits of change tend to be much more long lasting. What this book challenges you to do is to decide whether you are willing to tolerate some short-term pain, to achieve long-term gains. Examples of potential benefits of overcoming your shyness and social anxiety include the following: 幸运的是，克服社交焦虑也有许多好处。正如我们在上一节中提到的，克服焦虑的代价通常只是短期的不便。另一方面，改变带来的好处往往更加持久。本书挑战你去决定是否愿意忍受一些短期的痛苦，以换取长期的收益。克服害羞和社交焦虑的潜在好处包括以下几个方面：
Learning to feel more comfortable in feared social and performance situations 学会在害怕的社交和表演场合中感到更加自在
Meeting new friends 结识新朋友
Improving the quality of your relationships 提升你的人际关系质量
Learning to network more comfortably in situations related to your job or career 学会在与你的工作或职业相关的场合中更自如地建立人脉
Expanding the possible options for what you can do in your leisure time 拓展你休闲时间可选择的活动范围
Improving your job prospects (for instance, realizing new opportunities to get a promotion or to seek a higher-paying position) 改善你的就业前景（例如，发现晋升的新机会或寻求更高薪职位）
Opening up some opportunities for self-improvement by furthering your education 通过继续教育为自我提升打开一些机会
Learning to increase your enjoyment of life 学习提高生活的乐趣
Feeling more confident 感到更加自信
Increasing your ability to express yourself 增强自我表达的能力
Learning strategies that you may be able to apply to other problems, such as anger, depression, or a troubled relationship 你可能能够应用于其他问题的学习策略，例如愤怒、抑郁或困扰的关系
Based on this list of examples, or others that you can identify, can you think of benefits that would result from overcoming your social anxiety? Focus on benefits that are based on your own internal values and goals (for example, “I want to have closer friendships”), rather than the values and goals of others (for example, “My mother wants me to make new friends”). Questions like the ones listed below can be useful as you identify your own reasons for changing: 基于这份示例清单，或你能识别的其他示例，你能想到克服社交焦虑会带来哪些好处吗？请关注基于你自身内在价值观和目标的好处（例如，“我想拥有更亲密的友谊”），而非他人的价值观和目标（例如，“我母亲希望我结交新朋友”）。在你确定自己改变的理由时，下面列出的问题可能会有所帮助：
How would I like my life to be different in five years? 我希望五年后的生活有什么不同？
What would be better about my life if I felt more comfortable in social situations? 如果我在社交场合感到更自在，我的生活会有哪些改善？
What type of person would I like to be, and how is my social anxiety preventing me from being that type of person? 我想成为什么样的人，而我的社交焦虑是如何阻碍我成为那种人的？
What sorts of things do I miss about my life before social anxiety became as big a problem as it is now? 在社交焦虑变得如此严重之前，我错过了生活中的哪些事情？
Record your reasons for changing in the space below. 请在下面的空白处记录你改变的理由。
Now that you have had a chance to consider the costs and benefits of working on your social anxiety, you are in a better position to make a commitment to working on overcoming your fears. Assuming that you have decided to go ahead as planned, the remainder of this chapter will help you to consider the strategies best suited to your individual needs. 既然你已经有机会权衡了应对社交焦虑的利弊，你现在更有能力做出克服恐惧的承诺。假设你已经决定按计划进行，本章剩余部分将帮助你考虑最适合你个人需求的策略。
SETTING GOALS FOR CHANGE 设定改变的目标
Without setting specific goals or objectives, it will be impossible for you to evaluate whether you’re making the changes that you hope to make. Goals can be described in a number of different ways. First, goals can reflect either short-term or long-term changes that you would like to accomplish. For example, if you have a fear of public speaking, a reasonable one-week goal might be to ask a single question at a meeting at work, regardless of how anxious you feel. A six-month goal might be to give a thirty-minute presentation without feeling significant anxiety. As you go through the process of overcoming your social anxiety, it is important to identify short-term goals (for example, what you want to accomplish this week), medium-range goals (such as what you want to accomplish over the next few months), and long-range goals (for instance, what you want to accomplish over the next year or two). 如果不设定具体的目标或目的，你将无法评估自己是否正在实现希望达到的改变。目标可以用多种不同的方式来描述。首先，目标可以反映你希望完成的短期或长期改变。例如，如果你害怕公开演讲，一个合理的一周目标可能是在工作会议上提出一个问题，不管你感到多么焦虑。一个六个月的目标可能是在没有明显焦虑感的情况下做一个三十分钟的演讲。在克服社交焦虑的过程中，识别短期目标（例如，本周你想完成的事情）、中期目标（比如未来几个月你想完成的事情）和长期目标（例如，未来一两年你想完成的事情）是非常重要的。
Goals also can be described either as specific or general. A specific goal is more detailed than a general one. Therefore, specific goals are often better suited for guiding you in selecting appropriate treatment strategies, compared with general goals. Also, with specific goals, it is easier to measure whether your objectives are being met. Although it is okay to have a few general goals, you also should try to generate as many specific goals as possible. Examples of general and specific goals are listed below. 目标也可以描述为具体的或一般的。具体目标比一般目标更详细。因此，与一般目标相比，具体目标通常更适合指导你选择合适的治疗策略。此外，使用具体目标时，更容易衡量你的目标是否达成。虽然拥有一些一般目标是可以的，但你也应该尽量制定尽可能多的具体目标。以下列出了几个一般目标和具体目标的例子。
General Goal 一般目标
Specific Goal 具体目标
To be more comfortable during presentations 在演讲时更加自如
To have my fear level during presentations at my weekly sales meetings decrease from a level of 100 out of 100 to a level of 40 out of 100 在每周销售会议上，我的演讲恐惧程度从 100 分（满分 100）降低到 40 分
To ask someone on a date sometime 找个时间约某人出去
To ask John (or Jane) to have dinner with me by the end of this month 在本月底之前邀请约翰（或简）共进晚餐
To have more friends 拥有更多朋友
To meet at least three new friends by the end of this year, with whom I can see movies or watch sports 在今年年底之前结识至少三个新朋友，可以和他们一起看电影或观看体育比赛
To be comfortable in crowds 在人群中感到舒适
To be able to walk through a crowded mall or on a crowded street with my fear below a 30 or 40 out of 100 能够在拥挤的商场或街道上行走时，将恐惧感控制在 100 分中的 30 或 40 以下
To cope better with criticism 更好地应对批评
To be able to tolerate negative feedback on my annual performance review at work without becoming very upset and while still paying attention to all my positive achievements over the year 能够在工作年度绩效评估中容忍负面反馈，而不至于非常难过，同时仍然关注我全年所有的积极成就
To ask questions in class 在课堂上提问
To ask at least one question during each class over the rest of this semester 在本学期剩余的每节课上至少提一个问题
To deal better with groups 更好地应对小组活动
To be able to make small talk at a party while maintaining eye contact and speaking loudly enough for others to hear 能够在聚会上进行简短的交谈，同时保持眼神交流并且声音足够大让别人听见
General Goal Specific Goal
To be more comfortable during presentations To have my fear level during presentations at my weekly sales meetings decrease from a level of 100 out of 100 to a level of 40 out of 100
To ask someone on a date sometime To ask John (or Jane) to have dinner with me by the end of this month
To have more friends To meet at least three new friends by the end of this year, with whom I can see movies or watch sports
To be comfortable in crowds To be able to walk through a crowded mall or on a crowded street with my fear below a 30 or 40 out of 100
To cope better with criticism To be able to tolerate negative feedback on my annual performance review at work without becoming very upset and while still paying attention to all my positive achievements over the year
To ask questions in class To ask at least one question during each class over the rest of this semester
To deal better with groups To be able to make small talk at a party while maintaining eye contact and speaking loudly enough for others to hear| General Goal | Specific Goal |
| :--- | :--- |
| To be more comfortable during presentations | To have my fear level during presentations at my weekly sales meetings decrease from a level of 100 out of 100 to a level of 40 out of 100 |
| To ask someone on a date sometime | To ask John (or Jane) to have dinner with me by the end of this month |
| To have more friends | To meet at least three new friends by the end of this year, with whom I can see movies or watch sports |
| To be comfortable in crowds | To be able to walk through a crowded mall or on a crowded street with my fear below a 30 or 40 out of 100 |
| To cope better with criticism | To be able to tolerate negative feedback on my annual performance review at work without becoming very upset and while still paying attention to all my positive achievements over the year |
| To ask questions in class | To ask at least one question during each class over the rest of this semester |
| To deal better with groups | To be able to make small talk at a party while maintaining eye contact and speaking loudly enough for others to hear |
Now, think about what types of changes you would like to make. Specifically, think about aspects of your social anxiety (anxious beliefs, situations that you avoid, and so on) that you would like to change. Try to be realistic. Also, recognize that your goals may change. For example, right now you may not need to make presentations in your daily life. However, if you take a job that involves public speaking, your goals may have to be revised later to reflect this change. 现在，思考一下你想做出哪些改变。具体来说，思考你社交焦虑的哪些方面（焦虑的信念、你避免的情境等等）是你想要改变的。尽量现实一些。同时，也要认识到你的目标可能会发生变化。例如，现在你可能在日常生活中不需要做演讲。然而，如果你接受了一份需要公开演讲的工作，你的目标可能需要随后调整以反映这一变化。
We have included space for you to record your goals for the next month as well as your goals for one year from now. Of course, if you prefer, you may choose other time periods. The main point to remember is that you may have different short-term and long-term goals. Although some goals may be realistic targets for a year or two from now, they may not be realistic goals for one week or one month from now. 我们为你预留了空间来记录你未来一个月的目标以及一年后的目标。当然，如果你愿意，也可以选择其他时间段。需要记住的主要一点是，你可能会有不同的短期和长期目标。虽然有些目标可能是未来一两年内现实可达的，但它们可能不是未来一周或一个月内现实的目标。
One-Month Goals 一个月目标
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One-Year Goals 一年度目标
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REVIEWING PREVIOUS ATTEMPTS TO TREAT YOUR SOCIAL ANXIETY 回顾以往治疗社交焦虑的尝试
This section has two purposes. First, if you’ve tried to overcome your social anxiety in the past, it will help you review the treatments that worked for you and those that were not especially helpful. Second, this section will help you to identify possible reasons why certain previous attempts to overcome your social anxiety were not useful, if this was your experience. By identifying the reasons for previously successful and not-sosuccessful treatment attempts, you will be able to make more educated decisions about what types of strategies to try now. If a treatment has worked well in the past, you may want to try it again. If you did not benefit from a particular treatment previously, you may want to try something new. However, you should still consider giving a particular treatment another try if you didn’t give it a fair chance the first time. 本节有两个目的。首先，如果你过去曾尝试克服社交焦虑，它将帮助你回顾哪些治疗对你有效，哪些治疗效果不佳。其次，本节将帮助你识别某些以往克服社交焦虑尝试未能奏效的可能原因，如果这是你的经历。通过识别以往成功和不太成功的治疗尝试的原因，你将能够更有根据地决定现在尝试哪种策略。如果某种治疗过去效果良好，你可能想再次尝试。如果你之前未从某种治疗中受益，你可能想尝试新的方法。然而，如果你第一次没有给予某种治疗公平的机会，仍应考虑再试一次。
In the spaces that follow, check off any treatments that you have tried in the past. Also, describe the treatment and record whether the outcome was helpful. 在下面的空白处，勾选你过去尝试过的任何治疗方法。同时，描述该治疗并记录其效果是否有帮助。
Record of Previous Treatments 既往治疗记录
Yes 是
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Treatment 治疗
Medications 药物治疗
If yes, list drug names, duration of treatment, and maximum dosage for each. Also, describe any side effects that you experienced and whether or not each medication helped. Indicate if you took the medication as prescribed. 如果是，请列出药物名称、治疗持续时间及每种药物的最大剂量。同时，描述您经历的任何副作用以及每种药物是否有效。请注明您是否按处方服药。 qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad
Exposure to Feared Situations 暴露于恐惧情境
If yes, describe the treatment (including frequency of exposures, duration of treatment, types of situations practiced in, outcome). 如果是，请描述治疗情况（包括暴露的频率、治疗持续时间、练习的情境类型、结果）。 qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad Codnitive Therapy (This therapy is focused on teaching strategies for changing anxious thinking; it usually includes completion of thought records as a component.) If yes, describe the treatment (including duration of treatment, outcome). qquad\qquad 认知疗法（该疗法侧重于教授改变焦虑思维的策略；通常包括完成思维记录作为组成部分。）如果是，请描述治疗情况（包括治疗持续时间、结果）。 qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad Skills Training (This might include assertiveness training or a public speaking or communications course.) If yes, describe the treatment or course content (including duration of treatment, outcome). qquad\qquad 技能训练（这可能包括自信训练或公共演讲或沟通课程。）如果有，请描述治疗或课程内容（包括治疗时长、结果）。 qquad\qquad qquad\qquad qquad\qquad qquad\qquad
Insight-Oriented Therapy (This therapy is focused on early-childhood experiences and on helping you to understand the deep causes underlying a particular problem.) If yes, describe the treatment (duration of treatment, outcome). 洞察导向疗法（这种疗法侧重于早期儿童经历，帮助你理解某一特定问题的深层原因。）如果有，请描述治疗（治疗时长、结果）。 qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad Supportive Therapy (In this fairly unstructured therapy, the client describes experiences over the past week and the therapist offers support and perhaps suggestions for solving problems that arise from week to week.) If yes, describe the treatment (duration of treatment, outcome). qquad\qquad 支持性疗法（在这种相当无结构的疗法中，客户描述过去一周的经历，治疗师提供支持，或许还会提出解决每周出现问题的建议。）如果有，请描述治疗（治疗时长、结果）。 qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad Self-Help Book qquad\qquad 自助书籍
If yes, describe the treatment. (For instance, what book/s did you read? What approach did the book take? Did it help?) 如果是，请描述所接受的治疗。（例如，你读了哪些书？这些书采用了什么方法？它们有帮助吗？） qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad
Now that you have identified specific treatments you have tried in the past, the next step is to understand why a treatment was ineffective or only partially effective, if that was your experience. Listed below are some of the reasons why psychological treatments and medications are occasionally not helpful. 既然你已经确定了过去尝试过的具体治疗方法，下一步是了解为什么某些治疗无效或仅部分有效，如果这是你的经历。以下列出了一些心理治疗和药物偶尔无效的原因。
Why Psychological Treatments Sometimes Don't Help 为什么心理治疗有时不起作用
The therapy is an ineffective treatment for social anxiety. Many types of psychotherapy have never been studied for the treatment of social anxiety, and others have been found to be of little benefit. (Cognitive behavioral therapy is the best-studied approach and is well supported.) 该疗法对社交焦虑症无效。许多类型的心理治疗从未被研究用于治疗社交焦虑症，其他一些治疗则被发现效果甚微。（认知行为疗法是研究最充分且支持度最高的方法。）
The therapist is inexperienced either with the type of therapy being offered or the treatment of shyness and social anxiety, in particular. 治疗师对所提供的治疗类型或特别是对害羞和社交焦虑的治疗经验不足。
The frequency and intensity of exposure practices is too low. If you practice exposure to social situations too infrequently, you will be less likely to see the desired results. 暴露练习的频率和强度过低。如果你对社交情境的暴露练习过于稀少，你就不太可能看到理想的效果。
The treatment does not last long enough. You may not have benefited from previous therapy if you dropped out of treatment before positive results could be seen. 治疗持续时间不够长。如果你在看到积极效果之前就中断了治疗，可能无法从之前的治疗中受益。
An individual expects the treatment to be ineffective. There is evidence that a person’s expectations can affect the outcome of psychotherapy (Safren, Heimberg, and Juster 1997). 个体期望治疗无效。有证据表明，一个人的期望会影响心理治疗的结果（Safren、Heimberg 和 Juster，1997）。
The person does not comply with the treatment. If you miss sessions, arrive late for sessions, or don’t complete homework, therapy is less likely to be effective. 此人未遵守治疗方案。如果你缺席治疗课程、迟到或不完成作业，治疗效果可能会降低。
There are other problems or stresses in the person’s life that interfere with treatment (for example, severe depression, alcohol abuse, stressful job, marital problems, health issues). 此人生活中存在其他问题或压力，干扰了治疗（例如，严重抑郁、酗酒、压力大的工作、婚姻问题、健康问题）。
Why Medications Sometimes Don't Help 为什么药物有时不起作用
It is the wrong medication for the problem. Some medications have been shown to be more effective than others for treating social anxiety (see chapter 5). Furthermore, a medication that works for one person may not be the best choice for someone else. 所用药物不适合该问题。有些药物已被证明在治疗社交焦虑方面比其他药物更有效（见第 5 章）。此外，对一个人有效的药物，可能并不是另一个人的最佳选择。
The medication dosage is not high enough. 药物剂量不足。
The treatment does not last long enough. Some medications can take up to six weeks to have an effect. Also, stopping certain medications too soon can increase the chances of the anxiety coming back. 治疗时间不够长。有些药物可能需要长达六周才能起效。此外，过早停止某些药物可能会增加焦虑复发的几率。
An individual expects the treatment to be ineffective. As with psychotherapy, there is evidence that a person’s response to medication is affected by his or her expectations. 个体预期治疗无效。与心理治疗一样，有证据表明一个人对药物的反应受到其预期的影响。
The side effects are too unpleasant to tolerate. 副作用过于难以忍受。
The person is using drugs, drinking alcohol, or taking other medications that influence the effects of the medication for social anxiety. 此人正在使用药物、饮酒或服用其他影响社交焦虑药物效果的药物。
The person doesn’t comply with the treatment (for example, misses pills). 此人未遵守治疗方案（例如，漏服药物）。
If you have tried to overcome your social anxiety in the past, but found treatment to be ineffective or only partially effective, do you have any guesses about why it may not have worked as well as you had hoped it would? Based on your previous experiences with therapy or medication, are there strategies that you want to try again? 如果你过去尝试过克服社交焦虑，但发现治疗无效或仅部分有效，你是否有任何猜测为什么治疗效果没有达到预期？基于你之前的治疗或用药经验，有哪些策略是你想再次尝试的？
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Are there strategies that you definitely don’t think you should try again? 有没有哪些策略是你绝对认为不应该再尝试的？
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PROVEN STRATEGIES FOR OVERCOMING SOCIAL ANXIETY 克服社交焦虑的有效策略
There are hundreds of different approaches that people have used to overcome emotional difficulties, behavior problems, and bad habits. Some of these approaches include psychotherapy, medications, prayer, relaxation training, yoga, hypnosis, distraction, drinking alcohol or using drugs, exercise, changing diet, reward and punishment, herbal remedies, traditional remedies, acupuncture, education and reading about the problem, past-life regression, and so forth. Furthermore, each of these methods can be subdivided into even more categories. For example, there are many different types of psychotherapy and medications, some of which are more useful than others for a particular problem. 人们用来克服情绪困扰、行为问题和坏习惯的方法有数百种。这些方法包括心理治疗、药物治疗、祈祷、放松训练、瑜伽、催眠、分散注意力、饮酒或使用毒品、锻炼、改变饮食、奖惩、草药疗法、传统疗法、针灸、教育和阅读相关问题、前世回溯等等。此外，每种方法还可以细分为更多类别。例如，心理治疗和药物治疗就有许多不同类型，其中一些对特定问题更为有效。
Given all of the different available options, it can be very difficult for a consumer to select the best approach for overcoming a particular problem. 面对众多可选方案，消费者很难选择出克服某一特定问题的最佳方法。
For most of the methods listed previously, there is almost no controlled research examining their use in treating anxiety in general and social anxiety in particular. The term controlled is used to describe studies in which the investigators have examined the effects of a particular treatment while taking steps to ensure that any improvements that occur are, in fact, due to the treatment, rather than to other factors. Note that a lack of controlled research does not mean that a particular treatment is ineffective. It simply means we just don’t know whether the treatment works or how well it works. 对于前面列出的绝大多数方法，几乎没有受控研究来检验它们在治疗焦虑症，特别是社交焦虑症中的应用。所谓受控，是指研究者在研究某种特定治疗效果时，采取措施确保任何改善确实是由于该治疗本身，而非其他因素所致。需要注意的是，缺乏受控研究并不意味着某种治疗无效。它仅仅表示我们尚不清楚该治疗是否有效，或者其效果如何。
Even if someone seems to improve after using one of these methods, it can be difficult to know whether it was the treatment that had a beneficial effect or whether other factors contributed to the change. For example, as we mentioned earlier, someone’s expectations of improving during treatment can affect his or her improvement. Other reasons why people might improve with a particular treatment may include the passage of time. For some types of problems (such as depression), the symptoms may improve naturally over time, regardless of whether the sufferer receives any specific treatments. Changes in a person’s normal routines (for instance, a reduction of stress at work) also can contribute to improvements over and above any treatment effects. 即使有人在使用这些方法后似乎有所改善，也很难确定是治疗本身产生了有益效果，还是其他因素促成了这种变化。例如，正如我们之前提到的，一个人在治疗期间对改善的期望可能会影响其改善程度。人们在某种特定治疗下可能改善的其他原因还包括时间的推移。对于某些类型的问题（如抑郁症），症状可能会随着时间自然好转，无论患者是否接受了任何特定治疗。一个人日常生活习惯的变化（例如工作压力的减少）也可能促成超出治疗效果之外的改善。
Properly controlled research can help to determine whether the effects of a treatment are indeed due to the treatment rather than to other factors. One strategy used by researchers is the inclusion of a control group. For example, research studies that examine the effects of a medication on a particular problem usually give a percentage of the individuals in the study a placebo, which is, essentially, a pill that contains no real medication. This group is called the placebo control group. Typically, neither the doctor nor the patient knows whether the person is taking a placebo or the real medication until after the study ends. 适当控制的研究可以帮助确定治疗效果是否确实由于治疗本身，而非其他因素。研究人员采用的一种策略是设置对照组。例如，研究某种药物对特定问题影响的研究，通常会给部分参与者服用安慰剂，安慰剂本质上是一种不含有效药物的药丸。这个组被称为安慰剂对照组。通常，在研究结束之前，医生和患者都不知道该人服用的是安慰剂还是实际药物。
The test of whether a medication is helpful depends on how well people who took the medication respond compared with those who took the placebo. Including a placebo control group allows the researcher to directly measure the effects of the medication over and above the effects of the individual’s expectations about the treatment. Properly conducted studies examining the effects of psychological treatments also include appropriate control groups to aid in understanding why a particular treatment may appear to work. 判断一种药物是否有效，取决于服用该药物的人与服用安慰剂的人反应的差异。设置安慰剂对照组使研究者能够直接测量药物的效果，排除个体对治疗期望的影响。适当进行的心理治疗效果研究也会包括相应的对照组，以帮助理解某种治疗为何看似有效。
In this book, we have chosen to focus on techniques that have been shown in controlled research to be effective for helping people to overcome problems with social anxiety, shyness, and performance-related fears. In other words, these techniques have been shown to be effective compared with no treatment, placebo treatments, other forms of psychotherapy, or other appropriate control groups. The techniques we will focus on include two main groups of strategies: cognitive behavioral therapy and medications. 在本书中，我们选择专注于那些经过严格研究证明对帮助人们克服社交焦虑、害羞和与表现相关的恐惧有效的技术。换句话说，这些技术已被证明相比于无治疗、安慰剂治疗、其他形式的心理治疗或其他适当的对照组更为有效。我们将重点介绍的技术包括两大类策略：认知行为疗法和药物治疗。
Cognitive Behavioral Therapy 认知行为疗法
Cognitive behavioral therapy, or CBT, includes a group of techniques that are usually used together as a package. Numerous studies have shown that CBT is an effective 认知行为疗法，简称 CBT，包含一组通常作为整体使用的技术。大量研究表明，CBT 是一种有效的
way of overcoming social anxiety (for reviews, see Antony and Rowa 2008; Rodebaugh, Holaway, and Heimberg 2004). Cognitive behavioral therapy differs from other more traditional forms of therapy in the following ways: 克服社交焦虑的方法（综述见 Antony 和 Rowa 2008；Rodebaugh、Holaway 和 Heimberg 2004）。认知行为疗法与其他更传统的治疗形式在以下几个方面有所不同：
CBT is directive. In other words, the therapist is actively involved in the therapy and makes very specific suggestions. 认知行为疗法（CBT）是指导性的。换句话说，治疗师积极参与治疗，并提出非常具体的建议。
CBT’s focus is on changing a particular problem. Some other forms of therapy focus on helping the individual develop insight into or understanding of the deep-rooted causes of a problem but do not offer specific strategies for overcoming the problem. 认知行为疗法的重点是改变特定的问题。其他一些治疗形式则侧重于帮助个体深入了解或理解问题的根本原因，但不提供克服问题的具体策略。
CBT has a relatively brief duration. The typical course for social anxiety is ten to twenty sessions. 认知行为疗法的持续时间相对较短。社交焦虑的典型疗程为十到二十次。
CBT focuses on current beliefs and behaviors, which are thought to be responsible for maintaining the problem. Some traditional therapies tend to focus more on early childhood experiences. 认知行为疗法关注当前的信念和行为，这些被认为是维持问题的原因。一些传统疗法则更倾向于关注早期童年经历。
In CBT, the therapist and client are partners and work together during treatment. 在认知行为疗法中，治疗师和客户是合作伙伴，在治疗过程中共同努力。
In CBT, the client chooses the goals for therapy, with input from the therapist. 在认知行为疗法中，客户选择治疗目标，治疗师提供建议。
CBT usually includes strategies for measuring progress so that treatment techniques can be adjusted for maximum effectiveness. 认知行为疗法通常包括衡量进展的策略，以便调整治疗方法，达到最佳效果。
CBT involves changing beliefs and behaviors so that the client is able to better manage anxiety and to navigate anxiety-provoking situations. 认知行为疗法涉及改变信念和行为，使客户能够更好地管理焦虑并应对引发焦虑的情境。
Cognitive behavioral therapy for social anxiety includes three main types of strategies. Treatment almost always includes cognitive therapy and exposure to feared situations. In addition, social-skills training is sometimes included. 社交焦虑的认知行为疗法包括三种主要策略。治疗几乎总是包括认知疗法和对恐惧情境的暴露。此外，有时还会包括社交技能训练。
COGNITIVE THERAPY 认知疗法
The term cognitive refers to anything having to do with assumptions, beliefs, predictions, interpretations, visual imagery, memory, and other mental processes related to thinking. The basic underlying assumption of cognitive therapy is that negative emotions occur because people interpret situations in a negative or threatening way. For example, people who are convinced that others will judge them in a negative way or who are overly concerned about the opinions of others are bound to feel anxious or uncomfortable in certain social situations. Cognitive therapy teaches individuals to be more aware of their negative thoughts and to replace them with less negative thoughts. People learn 认知一词指的是与假设、信念、预测、解释、视觉想象、记忆以及其他与思维相关的心理过程有关的任何事物。认知疗法的基本假设是，负面情绪的产生是因为人们以负面或威胁性的方式解读情境。例如，那些坚信别人会以负面方式评判自己或过分在意他人看法的人，在某些社交场合必然会感到焦虑或不适。认知疗法教导个体更加意识到自己的负面想法，并用较少负面的想法来替代它们。人们学会
to treat their beliefs as guesses about the way things may be, rather than as facts. They are taught to examine the evidence supporting their anxious beliefs and to consider the possibility that an alternative belief is true. 将自己的信念视为对事物可能状态的猜测，而非事实。他们被教导去审视支持自己焦虑信念的证据，并考虑另一种信念可能为真的可能性。
For example, if Henry is very hurt and angry because a friend didn’t return his call, these negative feelings might stem from Henry’s belief that the friend doesn’t care about him. In cognitive therapy, Henry would be taught to consider alternative explanations for the friend’s behavior, including the possibility that the friend never received the message, forgot to return the call, or is out of town. After all, there are many possible reasons why a caring friend might not have returned Henry’s call quickly. 例如，如果亨利因为朋友没有回他的电话而感到非常受伤和愤怒，这些负面情绪可能源于亨利认为朋友不关心他。在认知疗法中，亨利会被教导去考虑朋友行为的其他解释，包括朋友可能根本没有收到信息、忘记回电话，或者正在外地。毕竟，有很多可能的原因可以解释一个关心他的朋友为什么没有迅速回亨利的电话。
At the beginning of treatment, diaries are used to record anxious thoughts and to counter them with more realistic predictions and interpretations. As people become more comfortable with the methods of challenging their unrealistic negative beliefs, their new ways of thinking become more automatic and the diaries are no longer needed. People learn to manage their anxious thoughts before they get out of control. Cognitive therapy techniques are described in detail in chapter 6. 在治疗初期，会使用日记来记录焦虑的想法，并用更现实的预测和解释来反驳这些想法。随着人们对挑战不切实际的负面信念的方法越来越熟悉，他们的新思维方式会变得更加自动化，日记也就不再需要。人们学会在焦虑的想法失控之前进行管理。认知疗法的技巧在第 6 章中有详细描述。
EXPOSURE 暴露法
Exposure involves gradually and repeatedly confronting feared situations until they no longer trigger fear. In most cases, exposure is viewed as a necessary component of CBT. In fact, exposure may be even more powerful than cognitive therapy as a way of changing anxious negative thinking. By exposing yourself to situations you fear, you will learn that the risk in these situations is minimal. Through direct experience, many of your anxious predictions and beliefs will be proven incorrect. You will also learn to better tolerate situations in which some of your beliefs actually may be true (for example, when another person actually does judge you negatively). Finally, exposure will provide you with an opportunity to practice your cognitive therapy skills and to improve upon any social or communication skills that may be rusty from having avoided social situations for so long. See chapters 7 through 9 for detailed instructions for designing and implementing exposure exercises. 暴露疗法涉及逐步且反复地面对恐惧的情境，直到这些情境不再引发恐惧。在大多数情况下，暴露疗法被视为认知行为疗法（CBT）的必要组成部分。事实上，暴露疗法可能比认知疗法更有效地改变焦虑的负面思维。通过让自己接触害怕的情境，你将学会这些情境中的风险是极小的。通过直接体验，许多你焦虑时的预测和信念将被证明是错误的。你还将学会更好地容忍那些你的一些信念实际上可能是真的情境（例如，当别人确实对你持负面评价时）。最后，暴露疗法将为你提供练习认知疗法技巧的机会，并改善因长时间回避社交情境而生疏的社交或沟通技能。有关设计和实施暴露练习的详细说明，请参见第 7 至 9 章。
IMPROVING SOCIAL SKILLS 提升社交技能
Social-skills training refers to the process of learning to improve the quality of your communication as well as other social behaviors, so there will be an increased likelihood of obtaining a positive response from others. Note that most people who are socially anxious have better social skills than they think they do. In fact, formal social-skills training is often not included in CBT programs, and people undergoing the treatment still respond quite well. Still, there is evidence that some people can benefit from learning a few new techniques to become more assertive, make small talk more effectively, improve their eye contact, and learn basic skills for dating or meeting new people. Chapter 10 describes strategies for improving social and communication skills. 社交技能训练是指学习提高你的沟通质量以及其他社交行为的过程，从而增加获得他人积极回应的可能性。请注意，大多数社交焦虑的人拥有的社交技能比他们自己认为的要好。事实上，正式的社交技能训练通常不包含在认知行为疗法（CBT）项目中，而接受治疗的人仍然反应良好。不过，有证据表明，有些人通过学习一些新技巧可以受益，比如变得更自信、更有效地进行闲聊、改善眼神交流，以及学习约会或结识新人的基本技能。第 10 章介绍了提升社交和沟通技能的策略。
Medications 药物治疗
Numerous medications have been shown to be effective for treating social phobia (Van Ameringen, Mancini, and Patterson, in press). Mostly, these include certain antidepressants that also target anxiety (such as paroxetine and venlafaxine) and certain anti-anxiety drugs (for instance, clonazepam). Typically, medications are taken on a daily basis. To varying degrees, all medications are associated with certain side effects. However, for most people, these side effects are quite manageable and most tend to decrease over time. 许多药物已被证明对治疗社交恐惧症有效（Van Ameringen、Mancini 和 Patterson，待发表）。主要包括某些同时针对焦虑的抗抑郁药（如帕罗西汀和文拉法辛）以及某些抗焦虑药（例如氯硝西泮）。通常，药物是每日服用的。所有药物在不同程度上都伴有一定的副作用。然而，对大多数人来说，这些副作用是相当可控的，并且大多数副作用会随着时间的推移而减轻。
Other Treatments 其他治疗方法
There are a number of other therapies that have preliminary or limited research support for treating social anxiety. Some of these treatments are quite new, and all of them have only been investigated in one or more studies for social anxiety (most of which are not controlled studies). Though it is too early to know if these therapies are as effective as CBT and medications, here are some brief descriptions of these approaches: 还有一些其他疗法对治疗社交焦虑有初步或有限的研究支持。这些治疗方法中有些相当新颖，且所有这些方法仅在一项或多项针对社交焦虑的研究中被调查（大多数研究并非对照研究）。虽然目前还无法确定这些疗法是否与认知行为疗法（CBT）和药物治疗一样有效，以下是这些方法的简要介绍：
MINDFULNESS TRAINING 正念训练
Mindfulness training involves learning to focus on one’s present experiences (for example, thoughts and feelings) without judging them or trying to change them and without dwelling on the past or anticipating the future (see Orsillo and Roemer 2005). Meditation is often a component of mindfulness training. Preliminary evidence supports the use of mindfulness for treating general worries (Roemer and Orsillo 2007) and for preventing relapse in depression (Williams et al. 2007). Evidence from a recent pilot study suggests that mindfulness training may be useful for treating social anxiety (Bögels, Sijbers, and Voncken 2006). 正念训练包括学习专注于当下的体验（例如，思想和感受），而不对其进行评判或试图改变，也不沉溺于过去或预期未来（参见 Orsillo 和 Roemer 2005）。冥想通常是正念训练的一个组成部分。初步证据支持使用正念来治疗一般性担忧（Roemer 和 Orsillo 2007）以及预防抑郁症复发（Williams 等人 2007）。最近一项初步研究的证据表明，正念训练可能对治疗社交焦虑有帮助（Bögels、Sijbers 和 Voncken 2006）。
ACCEPTANCE AND COMMITMENT THERAPY (ACT) 接受与承诺疗法（ACT）
ACT is a relatively new form of therapy that is related to mindfulness training in that a goal of this treatment is to teach people to accept their experiences (including emotions, thoughts, imagery, and other experiences) rather than trying to control, fight, or change them (Hayes and Smith 2005). Mindfulness training is used as part of ACT, but other strategies are used as well. In addition to acceptance, people receiving ACT are also encouraged to make a commitment to live a life that is consistent with their own values and goals, which typically involves changing behaviors. Though ACT is often presented as an alternative to CBT, it actually overlaps with CBT quite a bit. For example, ACT for anxiety and CBT for anxiety both use exposure as a component (Eifert and Forsyth 2005). A preliminary, uncontrolled study suggests that ACT may lead to reductions in social anxiety (Ossman et al. 2006). ACT 是一种相对较新的治疗方法，与正念训练相关，因为该治疗的目标是教导人们接受他们的体验（包括情绪、想法、意象和其他体验），而不是试图控制、抗拒或改变它们（Hayes 和 Smith 2005）。正念训练是 ACT 的一部分，但也使用其他策略。除了接受之外，接受 ACT 的人还被鼓励承诺过一种与自己价值观和目标一致的生活，这通常涉及行为的改变。虽然 ACT 常被作为认知行为疗法（CBT）的替代方案，但实际上两者有很大重叠。例如，针对焦虑的 ACT 和针对焦虑的 CBT 都将暴露作为一个组成部分（Eifert 和 Forsyth 2005）。一项初步的、无对照研究表明，ACT 可能有助于减少社交焦虑（Ossman 等人 2006）。
APPLIED RELAXATION TRAINING 应用放松训练
Applied relaxation involves the combination of learning to relax the muscles of the body with exposure to increasingly challenging situations. A few studies suggest that applied muscle relaxation may be useful for social anxiety (Jerremalm, Johansson, and Öst, 1980; Osberg 1981). However, it is difficult to know whether this approach is effective because of the relaxation component, the exposure to feared situations, or both. There are no studies investigating whether relaxation training adds any benefit over and above the effects of exposure alone. 应用放松法结合了学习放松身体肌肉与逐步面对越来越具挑战性的情境。一些研究表明，应用肌肉放松法可能对社交焦虑有帮助（Jerremalm、Johansson 和 Öst，1980；Osberg，1981）。然而，很难确定这种方法的有效性是来自放松成分、面对恐惧情境的暴露，还是两者兼有。目前尚无研究探讨放松训练是否在单纯暴露疗法的基础上带来额外益处。
INTERPERSONAL PSYCHOTHERAPY (IPT) 人际心理治疗（IPT）
IPT is a brief therapy that focuses exclusively on interpersonal aspects of a person’s problem, such as problems in the individual’s relationships with others. IPT has been studied primarily in people who are depressed, and it’s been shown in a number of wellcontrolled studies to be an effective treatment for depression, as well as certain other problems (Weissman, Markowitz, and Klerman 2007). Because of the interpersonal focus of IPT, some researchers have wondered whether it might also be effective for treating social anxiety. A preliminary, uncontrolled study (Lipsitz et al. 1999) suggests that IPT may be useful for treating social anxiety, though more research is needed. IPT 是一种简短的治疗方法，专注于个人问题中的人际方面，例如个体与他人关系中的问题。IPT 主要在抑郁症患者中进行研究，许多严格控制的研究表明，它不仅是治疗抑郁症的有效方法，也对某些其他问题有效（Weissman、Markowitz 和 Klerman 2007）。由于 IPT 侧重于人际关系，一些研究人员怀疑它是否也能有效治疗社交焦虑。一项初步的、无对照研究（Lipsitz 等，1999）表明，IPT 可能对治疗社交焦虑有用，但仍需更多研究。
CHOOSING AMONG TREATMENT OPTIONS 选择治疗方案
If you decide to try medications, you will probably need to get a prescription from a physician-usually your family doctor or a psychiatrist. However, note that in some states other professionals (for example, nurse practitioners) may be able to prescribe medications. In fact, two states (New Mexico and Louisiana) now allow psychologists with appropriate training to prescribe medications as well. For most people, a visit to your family doctor is a good place to start if you are interested in trying medications. He or she can make a referral to a psychiatrist or other professional if needed. If you are interested in trying a psychological treatment such as CBT, you have the option of trying to overcome the problem on your own or seeking professional help. 如果你决定尝试药物治疗，通常需要从医生那里获得处方——通常是你的家庭医生或精神科医生。不过，需要注意的是，在某些州，其他专业人员（例如执业护士）也可能有权开药。事实上，现在有两个州（新墨西哥州和路易斯安那州）允许经过适当培训的心理学家开药。对于大多数人来说，如果你有兴趣尝试药物治疗，先去看家庭医生是一个不错的起点。如果需要，他或她可以推荐你去看精神科医生或其他专业人员。如果你有兴趣尝试认知行为疗法（CBT）等心理治疗，你可以选择自己努力克服问题，或者寻求专业帮助。
Self-Help or Professional Help? 自助还是专业帮助？
For some people, a self-help approach such as that described in this book may be sufficient. In fact, a study by Moore, Braddock, and Abramowitz (2007) found that most people who used the first edition of this book achieved significant reduction in their social anxiety, even without any additional therapy. However, for others, a self-help book alone is not enough, and many people find that the added structure and support provided by a therapist is important. If you decide to seek professional help, this book 对于某些人来说，本书中描述的自助方法可能已经足够。事实上，Moore、Braddock 和 Abramowitz（2007 年）的一项研究发现，大多数使用本书第一版的人即使没有接受额外的治疗，也实现了社交焦虑的显著减轻。然而，对于其他人来说，仅靠自助书籍是不够的，许多人发现治疗师提供的额外结构和支持非常重要。如果你决定寻求专业帮助，本书
can still help to reinforce what you learn in therapy. An important part of CBT involves educating the client (often using self-help readings) and encouraging the client to practice the various CBT techniques between sessions. In other words, CBT conducted with a therapist often includes a self-help component. Combining a self-help book with your therapy may even reduce the number of therapy sessions needed (Rapee et al. 2007). For more information on finding a therapist, see the section on seeking professional help that appears later in this chapter. 仍然可以帮助巩固你在治疗中学到的内容。认知行为疗法（CBT）的一个重要部分是教育客户（通常通过自助读物）并鼓励客户在两次治疗之间练习各种 CBT 技巧。换句话说，治疗师指导下的 CBT 通常包含自助成分。将自助书籍与治疗结合使用，甚至可能减少所需的治疗次数（Rapee 等，2007 年）。有关寻找治疗师的更多信息，请参见本章后面关于寻求专业帮助的部分。
Cognitive Behavioral Therapy or Other Psychotherapy? 认知行为疗法还是其他心理治疗？
In almost all cases, we recommend cognitive therapy and exposure as the psychological treatment of choice for social phobia. Adding social-skills training to the program may be useful for some individuals as well. As for other psychological therapies, although they certainly have a place for treating certain types of problems, they are not sufficiently proven when it comes to treating social phobia and other anxiety-related conditions. 在几乎所有情况下，我们推荐认知疗法和暴露疗法作为社交恐惧症的首选心理治疗方法。对于某些个体，加入社交技能训练也可能有帮助。至于其他心理疗法，虽然它们在治疗某些类型的问题时确实有其作用，但在治疗社交恐惧症和其他焦虑相关疾病方面尚未得到充分证实。
Some people with whom we have worked have reported benefits from combining CBT with another form of psychotherapy. In these cases, typically they have seen one therapist for CBT and another for dealing with other issues (for example, marital problems, coping with childhood abuse). Although this approach sometimes works well, we recommend that your two therapists stay in close contact with each other so that they can ensure they are not giving you contradictory messages during therapy. 我们合作过的一些人报告说，将认知行为疗法（CBT）与另一种心理治疗形式结合使用带来了益处。在这些情况下，通常他们会找一位治疗师进行 CBT，另一位治疗师处理其他问题（例如婚姻问题、应对童年虐待）。虽然这种方法有时效果不错，但我们建议你的两位治疗师保持密切联系，以确保他们在治疗过程中不会给你传递矛盾的信息。
Medication or CBT? 药物治疗还是认知行为疗法？
A number of studies have investigated whether CBT, medications, or their combination work best (Antony and Rowa 2008). Although there are some differences across studies, the overall pattern of findings has been that all three of these approaches are about equally effective, at least in the short term. For example, in the largest study conducted to date, CBT, fluoxetine (an antidepressant), and a combination of fluoxetine and CBT were all found to be about equally effective and were all more effective than placebo (Davidson et al. 2004). 许多研究探讨了认知行为疗法（CBT）、药物治疗或两者结合哪种效果更好（Antony 和 Rowa 2008）。尽管各研究之间存在一些差异，但总体发现的模式是，这三种方法在短期内效果大致相当。例如，在迄今为止最大规模的研究中，CBT、氟西汀（一种抗抑郁药）以及氟西汀与 CBT 的结合均被发现效果相当，且均优于安慰剂（Davidson 等，2004）。
Although these approaches are about equally effective in the short term, CBT tends to be a more effective treatment than medications over the long term (Liebowitz et al. 1999). In other words, once all treatments have stopped, people who have been only taking medications are more likely to experience a return of symptoms than people who had CBT. 尽管这些方法在短期内效果相当，但从长期来看，CBT 往往比药物治疗更有效（Liebowitz 等，1999）。换句话说，一旦所有治疗停止，仅服用药物的人比接受过 CBT 的人更可能出现症状复发。
Also, just because these three approaches are about equally effective on average, that doesn’t mean that they are equally likely to be effective for you. Some people seem to do better with medications, whereas others seem to do best with CBT or a combination of these approaches. The approach we usually recommend is to start with either CBT or medication, and then introduce the other treatment after several months, if needed. 此外，尽管这三种方法的平均效果大致相当，但这并不意味着它们对你同样有效。有些人似乎对药物治疗效果更好，而另一些人则在认知行为疗法（CBT）或这两种方法的结合中效果最佳。我们通常建议的做法是先从 CBT 或药物治疗开始，如果需要，再在几个月后引入另一种治疗方法。
Group or Individual Therapy? 团体治疗还是个别治疗？
Cognitive behavioral therapy can be delivered either individually or in groups. Both approaches work well. Although most studies have found group and individual therapies for social anxiety to be about equally effective, some have found an advantage for individual therapy (for a review, see Bieling, McCabe, and Antony 2006). 认知行为疗法可以以个别或团体形式进行。两种方法都有效。虽然大多数研究发现团体和个别治疗对社交焦虑的效果大致相当，但也有一些研究发现个别治疗更有优势（综述见 Bieling、McCabe 和 Antony 2006 年）。
Regardless of which approach you choose, you should be aware of the advantages and disadvantages of each. Group treatment gives people an opportunity to meet other people with the same problem. This allows people to learn from the mistakes and successes of others and reminds them that they are not the only ones suffering from this problem. Group treatment also provides clients with opportunities to interact with other individuals who can participate in exposure exercises and role-play practices. For example, group members can be an audience during exposures that involve giving presentations. 无论你选择哪种方法，都应了解各自的优缺点。团体治疗为人们提供了与有相同问题的其他人见面的机会。这使人们能够从他人的错误和成功中学习，并提醒他们自己并不是唯一遭受此问题困扰的人。团体治疗还为客户提供了与其他个体互动的机会，这些人可以参与暴露练习和角色扮演练习。例如，团体成员可以在涉及做演讲的暴露练习中充当观众。
The cost is another advantage of group therapy. Because you are sharing the therapist’s time with other people, the cost per session is often lower than for individual therapy. If you decide to enter group treatment for social anxiety, we recommend that you try to find a group that focuses exclusively on anxiety problems, and ideally on social anxiety (rather than a group that includes people who suffer from a wide range of different problems). You are most likely to find a specialized social anxiety group at an anxiety disorders specialty clinic. 费用是团体治疗的另一个优势。因为你与其他人共享治疗师的时间，每次治疗的费用通常低于个别治疗。如果你决定参加社交焦虑的团体治疗，我们建议你尽量找到专注于焦虑问题的团体，最好是专门针对社交焦虑的团体（而不是包含患有各种不同问题的人的团体）。你最有可能在焦虑障碍专科诊所找到专门的社交焦虑团体。
Individual therapy also has advantages. First, it can be less scary than group therapy, particularly at the beginning. As you can imagine, people with social phobia are often quite terrified of starting group treatment, although anxiety about speaking in front of the group usually diminishes after the first few weeks. Furthermore, with individual therapy, you don’t have to share your time with other group members. And, because there is more time to focus on you, the program can be individually tailored to suit your personal needs. Individual therapy also has advantages from a scheduling perspective. If you miss a session due to illness or vacation, usually you can just reschedule an individual appointment. In contrast, if you miss a group session, catching up on the material that you missed may be more complicated. 个别治疗也有其优势。首先，它可能比团体治疗更不令人害怕，尤其是在开始阶段。正如你可以想象的，社交恐惧症患者通常对开始团体治疗感到非常恐惧，尽管在最初几周后，在团体面前发言的焦虑通常会减轻。此外，通过个别治疗，你不必与其他团体成员分享时间。并且，由于有更多时间专注于你，治疗方案可以根据你的个人需求进行个性化调整。个别治疗在时间安排方面也有优势。如果你因病或度假错过了一次治疗，通常可以重新安排个别预约。相比之下，如果你错过了团体课程，补上所缺内容可能会更复杂。
Whether you decide to seek group or individual treatment should depend on a careful weighing of all of these factors. Keep in mind, however, that you may not have a choice. Although the availability of CBT is increasing, this form of therapy is still hard to find in some places, either in a group or individual format. We would like to emphasize that, in choosing a therapy, the most important factor is finding a therapist who has experience in providing CBT for social anxiety. Whether you choose group or individual therapy should be a secondary issue, since both seem to work well. 你是否选择团体治疗还是个别治疗，应取决于对所有这些因素的仔细权衡。然而，请记住，你可能没有选择的余地。尽管认知行为疗法（CBT）的可用性正在增加，但在某些地方，这种治疗形式仍然难以找到，无论是团体还是个别形式。我们想强调的是，在选择治疗时，最重要的因素是找到一位有经验提供社交焦虑 CBT 的治疗师。你选择团体治疗还是个别治疗应是次要问题，因为两者似乎都效果良好。
THE IMPORTANCE OF REGULAR PRACTICE 定期练习的重要性
Although simply reading about how to overcome social phobia may be helpful, to make big changes in your social anxiety, it will be necessary for you to actually practice the 虽然仅仅阅读如何克服社交恐惧的内容可能有所帮助，但要在社交焦虑上取得重大改变，你实际上需要练习
techniques described throughout this book. For example, you will get more out of the cognitive strategies described in chapter 6 if you complete the monitoring forms and diaries and frequently take advantage of opportunities to challenge your anxious beliefs. 本书中描述的技巧。例如，如果你完成第 6 章中描述的监控表格和日记，并经常利用机会挑战你的焦虑信念，你将从认知策略中获得更多收益。
To get the most out of exposure practices, it will be important to enter feared situations as frequently as possible and to stay in the feared situations until your fear has decreased, or until you learn that your feared consequences don’t occur. Many of your exposure practices can be conducted during the course of your everyday life (for instance, having lunch with coworkers instead of eating alone), but other practices may require you to set aside time just for the exposure exercises. 为了最大限度地发挥暴露练习的效果，重要的是尽可能频繁地进入令你害怕的情境，并且在害怕的情境中停留，直到你的恐惧减轻，或者直到你了解到你害怕的后果并不会发生。你许多暴露练习可以在日常生活中进行（例如，与同事共进午餐而不是独自用餐），但其他练习可能需要你专门留出时间来进行暴露练习。
INCLUDING A HELPER OR CO-THERAPIST 包括助手或共同治疗师
It may be helpful to involve a helper or “co-therapist” in your treatment, for example, a friend, coworker, or family member. Your helper can provide you with opportunities to practice role-play exposures, such as presentations, simulated job interviews, making small talk, or asking another person out on a date. In addition, he or she can provide you with honest feedback about your performance and offer suggestions for improvement. 在治疗过程中，邀请助手或“共同治疗师”可能会有所帮助，例如朋友、同事或家庭成员。你的助手可以为你提供练习角色扮演暴露的机会，比如演讲、模拟面试、闲聊或邀请别人约会。此外，他或她还可以对你的表现提供诚实的反馈，并提出改进建议。
When choosing other people to help you out, we suggest that you select people whom you trust. The person should be someone who is supportive and unlikely to become frustrated or angry if things move slowly or if you are finding a particular situation difficult or anxiety provoking. If possible, your helper should read relevant sections of this book so that he or she has a better understanding of the treatment and how it works. If this is not practical, an alternative option would be to have you describe to your helper what his or her role will be during the practices. 在选择其他人来帮助你时，我们建议你选择你信任的人。这个人应该是支持你的，并且如果事情进展缓慢，或者你发现某个特定情境困难或引发焦虑，他或她不太可能感到沮丧或生气。如果可能的话，你的帮手应该阅读本书相关章节，以便更好地理解治疗方法及其运作方式。如果这不现实，另一种选择是由你向帮手描述他或她在练习中的角色。
DEALING WITH ADDITIONAL PROBLEMS 处理额外的问题
Many people who suffer from social anxiety also experience other problems, including other anxiety disorders, depression, alcohol or drug use problems, and relationship difficulties. In most cases, these other problems tend not to interfere with the treatment of social anxiety. However, if you are currently suffering from problems in addition to your shyness, there are two questions that you should consider. First, is your social anxiety the most important problem to focus on currently? If not, you should probably focus on the problem that is interfering the most with your life. For example, if your depression is more severe than your social anxiety, it may be important to deal with your depression first and then turn your attention to the social anxiety when your depression is under control. Second, are your other problems so severe that they are likely to get in the way of your social anxiety treatment? If so, you should work on the other problems first. For example, if you are drinking alcohol so frequently that you’re unlikely to follow 许多患有社交焦虑的人也会经历其他问题，包括其他焦虑障碍、抑郁症、酒精或药物使用问题以及人际关系困难。在大多数情况下，这些其他问题通常不会干扰社交焦虑的治疗。然而，如果你目前除了害羞之外还在遭受其他问题，有两个问题你需要考虑。首先，你的社交焦虑是否是当前最需要关注的问题？如果不是，你可能应该优先处理对你生活干扰最大的那个问题。例如，如果你的抑郁症比社交焦虑更严重，那么可能需要先处理抑郁症，待抑郁症得到控制后再转而关注社交焦虑。其次，你的其他问题是否严重到可能妨碍社交焦虑的治疗？如果是这样，你应该先处理其他问题。例如，如果你饮酒频繁，以至于不太可能坚持进行社交焦虑的治疗，...
through with the exercises in this book, then dealing with your drinking before working on your social anxiety is a good idea. 如果你无法完成本书中的练习，那么在处理社交焦虑之前先解决你的饮酒问题是个好主意。
SEEKING PROFESSIONAL HELP 寻求专业帮助
If you are interested in seeking professional help for your social anxiety, here are some additional suggestions to keep in mind. 如果您有兴趣寻求专业帮助来应对社交焦虑，以下是一些额外的建议供您参考。
How to Find a Therapist or Doctor 如何寻找治疗师或医生
One of the most difficult aspects of finding a therapist or doctor is knowing where to look. A good place to begin is with your family doctor, who will likely be aware of psychiatrists, psychologists, and anxiety specialty clinics in your area. You may also want to call nearby hospitals and clinics to see if they have programs that offer either CBT or medication for social anxiety. The Internet is also a great source of information about treatment options in your area. Check with your insurance company about the rules regarding coverage for treatment of psychological conditions. Your plan may have restrictions regarding who you can see and the number of sessions that are covered. 寻找治疗师或医生最困难的方面之一是知道从哪里开始。一个好的起点是您的家庭医生，他很可能了解您所在地区的精神科医生、心理学家以及专门治疗焦虑的诊所。您也可以致电附近的医院和诊所，了解他们是否有提供社交焦虑的认知行为疗法（CBT）或药物治疗的项目。互联网也是获取您所在地区治疗选项信息的好渠道。请向您的保险公司咨询有关心理疾病治疗的保险覆盖规定。您的保险计划可能对您可以就诊的人员以及覆盖的治疗次数有一定限制。
Another way to find help is to contact a national organization that focuses either on anxiety-related problems or CBT. For example, the Anxiety Disorders Association of America (www.adaa.org) offers information about treatment options and self-help groups across the United States and Canada (the ADAA has both consumer and professional members). The Association for Behavioral and Cognitive Therapies (www.abct.org) is a professional organization that also provides information on practitioners who treat anxiety-related problems. Full contact information for these and other organizations is provided in the resources section at the back of this book. You may also contact your state psychological or psychiatric associations to get information about psychologists or psychiatrists in your area. 另一种寻求帮助的方法是联系专注于焦虑相关问题或认知行为疗法（CBT）的全国性组织。例如，美国焦虑症协会（www.adaa.org）提供有关治疗选项和遍布美国及加拿大的自助团体的信息（ADAA 拥有消费者和专业会员）。行为与认知疗法协会（www.abct.org）是一个专业组织，也提供治疗焦虑相关问题的从业者信息。本书后面的资源部分提供了这些及其他组织的完整联系信息。您也可以联系所在州的心理学或精神病学协会，获取您所在地区心理学家或精神科医生的信息。
When choosing a professional, don’t be afraid to ask questions. Before making a commitment, here are some issues that you should clarify: 选择专业人士时，不要害怕提问。在做出承诺之前，您应澄清以下一些问题：
The type of treatment being offered. For example, if you are interested in a psychological treatment, you should ask whether the person is experienced in providing CBT for social and performance anxiety. 所提供的治疗类型。例如，如果您对心理治疗感兴趣，应询问该人士是否有为社交和表现焦虑提供认知行为疗法的经验。
The typical number of sessions recommended for treating this problem, recognizing that it is often difficult to know this before conducting a thorough assessment. In many cases, ten to twenty sessions is enough. 治疗此问题通常建议的疗程次数，需认识到在进行全面评估之前通常难以确定具体次数。许多情况下，十到二十次疗程足够。
The length of each session. One-hour sessions are typical, though longer time periods are sometimes needed for exposure sessions. 每次疗程的时长。通常为一小时，尽管有时暴露疗程需要更长时间。
The frequency of sessions. Weekly sessions are typical. 疗程的频率。通常为每周一次。
The cost per session and preferred method of payment. Are the fees flexible? 每次疗程的费用及首选支付方式。费用是否灵活？
The location and setting. For example, is the treatment conducted in a private office? A hospital? A university clinic? A community clinic? A research center? 地点和环境。例如，治疗是在私人办公室进行吗？医院？大学诊所？社区诊所？研究中心？
The availability of group vs. individual treatments for social anxiety. Either approach is likely to help. 社交焦虑的团体治疗与个别治疗的可用性。无论哪种方法都可能有帮助。
Who provides the treatment? A psychologist? Psychiatrist? Psychology student or psychiatric resident? How experienced is the person? Where was he or she trained? If it is a student therapist, how closely is he or she supervised? How experienced is the supervisor? Can you meet with the supervisor if you wish? 谁提供治疗？心理学家？精神科医生？心理学学生或精神科住院医师？此人有多经验？他或她在哪里接受培训？如果是学生治疗师，他或她受到多严格的监督？监督者有多经验？如果你愿意，可以见见监督者吗？
Types of Professionals 专业人员类型
If you are interested in receiving a psychological therapy, like CBT, your therapist can be a psychologist, physician, nurse, social worker, or professional from any of a number of other backgrounds. However, keep in mind that most practicing clinicians, regardless of their background, do not have extensive experience in providing CBT for anxiety-related problems. It is much more important that you find someone who is familiar with treating social anxiety using cognitive and exposure-based treatments than what degree the person has. Currently, psychologists are the most likely to have this background, but other professionals are increasingly being trained in providing cognitive and behavioral treatments. 如果您有兴趣接受心理治疗，比如认知行为疗法（CBT），您的治疗师可以是心理学家、医生、护士、社会工作者，或来自其他多个背景的专业人士。然而，请记住，大多数执业临床医生，无论其背景如何，都没有丰富的经验来为焦虑相关问题提供认知行为疗法。比起治疗师的学位，更重要的是您找到一个熟悉使用认知和暴露疗法治疗社交焦虑的人。目前，心理学家最有可能具备这方面的背景，但其他专业人士也越来越多地接受认知和行为治疗的培训。
Understanding the differences between types of therapists often can be confusing. A brief description of some of the main professionals who often provide CBT and related treatments follows: 了解不同类型治疗师之间的区别往往令人困惑。以下是一些经常提供认知行为疗法及相关治疗的主要专业人士的简要介绍：
Psychologist. In most places, psychologists who specialize in treating psychological disorders usually have a doctoral degree in clinical or counseling psychology. Often, this degree is a Ph.D. (which includes significant training in both research and in providing clinical care), although it may also be a Psy.D. (indicating a primary training focus on providing clinical services and relatively less emphasis on research) or an Ed.D. (indicating training that stems from an educational psychology perspective). Typically, the training of a psychologist includes an undergraduate bachelor’s degree (four years), followed by an additional five to eight years of graduate training. In some states and provinces, psychology practitioners with a master’s degree (usually two years of graduate training) can also call themselves psychologists, whereas in other places, master’s level 心理学家。在大多数地方，专门治疗心理障碍的心理学家通常拥有临床或咨询心理学的博士学位。这个学位通常是博士学位（Ph.D.），该学位包括大量的研究培训和临床护理培训，尽管也可能是心理学博士（Psy.D.），这表明主要培训重点是提供临床服务，研究方面相对较少，或者是教育学博士（Ed.D.），表明培训来源于教育心理学视角。通常，心理学家的培训包括四年的本科学士学位，随后是五到八年的研究生培训。在一些州和省，拥有硕士学位（通常是两年研究生培训）的心理学从业者也可以称自己为心理学家，而在其他地方，硕士级别的
clinicians are called by other terms (for example, psychological associate, psychotherapist, psychometrist). 临床医生则被称为其他名称（例如，心理学助理、心理治疗师、心理测量师）。
Psychiatrist. A psychiatrist is a physician who has specialized in treating mental health problems after completing four years of medical school. Typically, this specialty training includes a five-year residency and also may include additional fellowship training. Psychiatrists are more likely than other types of professionals to understand and treat anxiety from a biological perspective, although increasingly, psychiatric training programs are requiring training in CBT. Advantages of being treated by a psychiatrist over other types of professionals include the opportunity to obtain medications in addition to other forms of therapy, as well as the opportunity to be assessed by a physician who is uniquely qualified to recognize medical conditions that may be contributing to the problem. 精神科医生。精神科医生是在完成四年医学院学习后，专门治疗心理健康问题的医生。通常，这一专业培训包括五年的住院医师培训，有时还包括额外的研究员培训。与其他类型的专业人员相比，精神科医生更有可能从生物学角度理解和治疗焦虑，尽管越来越多的精神科培训项目要求接受认知行为疗法（CBT）培训。由精神科医生治疗的优势包括除了其他形式的治疗外，还能获得药物治疗的机会，以及由具备独特资格识别可能导致问题的医疗状况的医生进行评估的机会。
Social worker. Social workers are trained to do many different things including helping people to deal better with their relationships, solve their personal and family problems, and learn to cope better with day-to-day stresses. They may help people to deal with the stresses of inadequate housing, unemployment, lack of job skills, financial distress, serious illness or disability, substance abuse, unwanted pregnancy, and other hardships. Most social workers specialize, and some end up providing psychotherapy either in a private practice or a hospital or agency setting. Although CBT is seldom a formal part of social-work training programs, some social workers obtain specialized training in CBT following their formal schooling. 社会工作者。社会工作者接受过多方面的培训，包括帮助人们更好地处理人际关系，解决个人和家庭问题，以及学会更好地应对日常压力。他们可能帮助人们应对住房不足、失业、缺乏职业技能、经济困境、严重疾病或残疾、药物滥用、意外怀孕及其他困难带来的压力。大多数社会工作者都有专业方向，有些最终在私人诊所、医院或机构环境中提供心理治疗。尽管认知行为疗法（CBT）很少作为社会工作培训项目的正式内容，但一些社会工作者在完成正规教育后会接受 CBT 的专业培训。
Other professions. Professionals from a variety of other groups may be trained to provide CBT or other forms of psychotherapy. These include some family physicians, nurses, occupational therapists, clergy or other religious leaders, and even psychotherapists without any formal degree in a mental-health related field. As mentioned earlier, it is more important to know whether the person you’re seeing has the experience and expertise in treating social anxiety using strategies that have been proven to be useful than whether the person is a nurse, family doctor, psychologist, psychiatrist, occupational therapist, social worker, or a student in one of these fields. 其他职业。来自各种其他群体的专业人员可能接受过认知行为疗法（CBT）或其他形式心理治疗的培训。这些包括一些家庭医生、护士、职业治疗师、牧师或其他宗教领袖，甚至是没有任何心理健康相关领域正式学位的心理治疗师。如前所述，重要的是了解你所见的这个人在使用已被证明有效的策略治疗社交焦虑方面是否有经验和专业知识，而不是这个人是护士、家庭医生、心理学家、精神科医生、职业治疗师、社会工作者，还是这些领域的学生。
FINAL QUESTIONS REGARDING TREATMENT OF SOCIAL ANXIETY 关于社交焦虑治疗的最终问题
Here are some answers to a few additional frequently asked questions. 以下是对一些额外常见问题的回答。
How long does treatment take? As mentioned earlier, cognitive behavioral treatment for social and performance anxiety typically takes between ten and twenty sessions. Sometimes a person may make significant gains after just three or four sessions, particularly if the fear is very mild. Other times, treatment may last many months or even 治疗需要多长时间？如前所述，针对社交和表现焦虑的认知行为治疗通常需要十到二十次疗程。有时，如果恐惧非常轻微，患者在仅仅三到四次疗程后就可能取得显著进展。其他时候，治疗可能持续数月甚至更长。
years. If you are being treated with medication (particularly antidepressants), it is usually recommended that you stay on the medication for six months to a year or more before slowly decreasing the dosage and eventually discontinuing the medication. If the symptoms return, it may be necessary to resume taking the medication or to try a different form of treatment. 多年。如果你正在接受药物治疗（尤其是抗抑郁药），通常建议你服用药物六个月到一年或更长时间，然后逐渐减少剂量，最终停药。如果症状复发，可能需要重新服药或尝试其他治疗方法。
Are the effects of treatment long lasting? As we discussed earlier, the effects of CBT tend to be relatively long lasting, although you may experience some bad days occasionally. In contrast, stopping medication treatment suddenly is more likely to lead to a return of the anxiety. You can protect against this to some degree by staying on the medication for a longer period (perhaps at a reduced “maintenance” dosage) and by stopping the medication very gradually. Also, stopping certain types of medications is more likely to lead to a return of symptoms than stopping other medications, as reviewed in chapter 5. It is advisable to discuss reducing or stopping medication with the professional who is prescribing it for you before you change the dose you’re taking. 治疗效果能持续多久？如前所述，认知行为疗法（CBT）的效果通常较为持久，尽管你偶尔可能会有情绪低落的日子。相比之下，突然停止药物治疗更容易导致焦虑症状的复发。你可以通过延长服药时间（可能采用较低的“维持”剂量）并非常缓慢地停药，在一定程度上防止症状复发。此外，停止某些类型的药物比停止其他药物更容易导致症状复发，这一点在第五章中有详细介绍。在调整剂量之前，建议先与你为你开药的专业人员讨论减少或停止用药的事宜。
Will you be completely “cured”? A small percentage of people who have significant social anxiety are able to reach a point at which they rarely experience any social anxiety at all. Similarly, a small percentage of people do not obtain any benefit from either CBT or medications. For most people, however, the result of treatment is somewhere in between these two extremes. It is realistic to expect that proper treatment is likely to lead to a significant decrease in your social anxiety, avoidance behaviors, and impairment of day-to-day life. However, it is also likely that there will remain some situations that will still be anxiety provoking, at least to some extent. This outcome may not seem too bad if you remember that most people experience social and performance anxiety from time to time. 你会完全“治愈”吗？一小部分有严重社交焦虑的人能够达到几乎不再经历任何社交焦虑的程度。同样，也有一小部分人从认知行为疗法（CBT）或药物治疗中没有获得任何益处。然而，对于大多数人来说，治疗的结果介于这两个极端之间。现实的期望是，适当的治疗很可能会显著减少你的社交焦虑、回避行为以及日常生活中的功能障碍。但也很可能仍会存在一些情境，至少在某种程度上仍会引发焦虑。如果你记得大多数人时不时都会经历社交和表现焦虑，这样的结果可能看起来并不算太糟。
What if you don’t like your therapist or doctor? Although it is unrealistic to expect to be feeling better after only a few weeks, you should know after one or two meetings whether you are comfortable working with your therapist or doctor. If you are not pleased with how things are going, consider trying someone else. Within six to eight weeks after beginning either CBT or medication, you should begin to see changes. If changes have not occurred after two months, you should talk to your doctor or therapist about the possible reasons for the lack of improvement and consider other treatment options. 如果你不喜欢你的治疗师或医生怎么办？虽然期望在短短几周内感觉好转是不现实的，但你应该在一两次会面后就能判断自己是否愿意与治疗师或医生合作。如果你对目前的情况不满意，可以考虑换一个人。在开始认知行为疗法（CBT）或服用药物后的六到八周内，你应该开始看到一些变化。如果两个月后仍未见变化，你应与医生或治疗师讨论可能导致无改善的原因，并考虑其他治疗方案。
MEASURING CHANGE DURING TREATMENT 治疗期间的变化测量
In chapter 3, we emphasized the importance of monitoring your progress throughout your treatment program. We recommend that periodically (every few weeks) you reflect on your progress by considering what types of changes you have made and what changes remain to be accomplished. Depending on your progress, you may decide to revise your 在第三章中，我们强调了在整个治疗过程中监测进展的重要性。我们建议你定期（每隔几周）反思自己的进展，考虑自己已经取得了哪些变化，以及还需要完成哪些变化。根据你的进展情况，你可能会决定修改你的
treatment plan. You may also decide to update your treatment goals. We recommend that you occasionally complete some of the forms in chapter 3 as a way of assessing whether your social anxiety is improving. 治疗计划。你也可能会决定更新你的治疗目标。我们建议你偶尔填写第三章中的一些表格，以评估你的社交焦虑是否有所改善。
DEVELOPING A COMPREHENSIVE TREATMENT PLAN 制定全面的治疗计划
In chapters 1 and 2, you learned about the nature and causes of social anxiety. In chapter 3, you completed a thorough assessment of your own anxiety symptoms. Then, you continued the self-assessment process throughout this chapter, as you reviewed your previous attempts at treatment and developed your treatment goals. You are now ready to develop a treatment plan. By now, you should have a good idea of what you need to work on and whether you will try to overcome your social anxiety on your own or with the help of a professional therapist or physician. 在第 1 章和第 2 章中，你了解了社交焦虑的本质和成因。在第 3 章中，你完成了对自己焦虑症状的全面评估。然后，在本章中你继续进行自我评估，回顾了之前的治疗尝试并制定了治疗目标。现在，你已经准备好制定治疗计划。到目前为止，你应该对自己需要努力的方向有了清晰的认识，并且决定是自己克服社交焦虑，还是寻求专业治疗师或医生的帮助。
If you are considering trying medication, we recommend that you read chapter 5 next. Chapter 5 reviews the various medications that have been shown to be useful for treating social and performance anxiety. If you are interested in trying cognitive behavioral techniques, we suggest that you develop a treatment schedule for the next few months. The following list is one example of such a schedule: 如果你考虑尝试药物治疗，我们建议你接下来阅读第 5 章。第 5 章回顾了多种已被证明对治疗社交和表现焦虑有效的药物。如果你有兴趣尝试认知行为技术，我们建议你为接下来的几个月制定一个治疗时间表。以下列表是此类时间表的一个示例：
In the next week, read chapter 6 and begin to work on changing your negative thinking patterns. Chapter 6 includes a number of effective cognitive strategies as well as diaries that you should complete several times per week. 在接下来的一周内，阅读第 6 章并开始着手改变你的消极思维模式。第 6 章包含许多有效的认知策略以及你应每周多次完成的日记。
Continue to practice the cognitive strategies for two to three weeks before moving on to exposure-based techniques (chapters 7 through 9). 继续练习认知策略两到三周，然后再开始基于暴露的技术（第 7 至第 9 章）。
When you are ready to begin exposure practices, begin reading chapters 7 and 8 . As you read these chapters, you will have the opportunity to plan exposures designed specifically for your own pattern of fear and avoidance. We recommend that you practice the situational exposure strategies for five or six weeks before moving on to chapter 9. 当你准备好开始暴露练习时，开始阅读第 7 章和第 8 章。在阅读这些章节时，你将有机会为自己特定的恐惧和回避模式设计暴露计划。我们建议你在进入第 9 章之前，练习情境暴露策略五到六周。
At the same time that you are practicing exposures, you should continue to practice using the cognitive strategies that you will learn in chapter 6. By using the cognitive strategies and practicing exposures to feared situations, you should notice your fear beginning to decrease. 在练习暴露的同时，你应继续练习第 6 章中学到的认知策略。通过使用认知策略并练习面对恐惧情境，你应该会注意到恐惧开始减轻。
After five or six weeks of practicing exposure to feared situations, read chapter 9 to learn more about how to expose yourself to feared physical sensations. If you are frightened of feeling certain sensations when you are anxious, we recommend that you spend two to three weeks practicing the 经过五到六周对恐惧情境的暴露练习后，阅读第 9 章，了解更多关于如何暴露自己于恐惧的身体感觉的方法。如果你害怕在焦虑时感受到某些特定的感觉，我们建议你花两到三周时间练习第 9 章中描述的
strategies described in chapter 9. At the same time, continue to practice the cognitive and exposure techniques from the earlier chapters. 策略。同时，继续练习前几章中的认知和暴露技巧。
If there are social skills that you would like to improve, this will be the time to use the exercises described in chapter 10. Again, we recommend that you do not stop using the skills that you learned earlier, particularly the cognitive and exposure-based strategies. 如果你有想要提升的社交技能，现在就是使用第 10 章中描述的练习的时机。同样，我们建议你不要停止使用之前学到的技能，特别是认知和基于暴露的策略。
At this point, several months will have passed and your anxiety will be likely to have improved significantly. We recommend that you read chapter 11 at this point, which discusses ways of maintaining the gains you have made so far. 此时，已经过去了几个月，你的焦虑很可能已经有了显著改善。我们建议你此时阅读第 11 章，讨论如何维持迄今为止取得的进步。
If you are curious and you want to read later sections in the book now, that’s fine. However, it’s important that you go back and practice the strategies in each chapter before moving on to the next set of techniques. These strategies are the building blocks that eventually will lead to an improvement in your social anxiety. 如果你感到好奇，想现在就阅读本书后面的章节，也没关系。不过，重要的是你要回过头来练习每一章中的策略，然后再继续学习下一组技巧。这些策略是构建块，最终会帮助你改善社交焦虑。
After completing this chapter, a number of issues should be clearer to you. First, you should have a better idea of whether this is the best time for you to work on overcoming your social anxiety. Second, you should have formulated a number of treatment goals, both for the short term and the long term. Finally, it is likely that you will have considered the various treatment options and identified your own treatment preferences. The remaining chapters in this workbook provide more detailed instructions in how to take advantage of particular strategies for managing social anxiety. 完成本章后，你应该对一些问题有更清晰的认识。首先，你应该更清楚现在是否是你克服社交焦虑的最佳时机。其次，你应该制定了一些治疗目标，包括短期和长期的目标。最后，你可能已经考虑了各种治疗选项，并确定了你自己的治疗偏好。本工作手册剩余的章节将提供更详细的指导，帮助你利用特定策略来管理社交焦虑。
CHAPTER 5 第五章
Medications for Social Anxiety and Social Anxiety Disorder 社交焦虑及社交焦虑障碍的药物治疗
DECIDING TO TAKE MEDICATION 决定服用药物
As discussed in earlier chapters, two approaches have been shown to be useful for overcoming social anxiety: medications and cognitive behavioral therapy (CBT). Chapter 4 reviewed the key points to keep in mind when deciding whether to use drug treatments to overcome your symptoms of social anxiety. Medications and CBT have been shown to be about equally effective in the short term for treating social anxiety. Still, each approach has advantages and disadvantages. 如前几章所述，克服社交焦虑有两种有效方法：药物治疗和认知行为疗法（CBT）。第四章回顾了在决定是否使用药物治疗来缓解社交焦虑症状时需要牢记的关键点。药物治疗和认知行为疗法在短期内对社交焦虑的治疗效果大致相当。不过，每种方法都有其优缺点。
Advantages of Medications Compared with CBT 药物治疗相较于认知行为疗法的优势
Medications are often easier to get. Any physician (for example, family doctor or psychiatrist) can prescribe medications, as can certain other professionals. In contrast, therapists who have specialized training in providing CBT are often more difficult to find. 药物通常更容易获得。任何医生（例如家庭医生或精神科医生）都可以开药，某些其他专业人员也可以开药。相比之下，接受过专门培训提供认知行为疗法的治疗师往往更难找到。
Drug treatments are easy to use and don’t take up much time. You just need to remember to take your pills. In contrast, CBT requires a lot of hard work and can be time consuming. 药物治疗使用方便，不占用太多时间。你只需要记得按时服药。相比之下，认知行为疗法（CBT）需要大量努力，且可能耗时较长。
Medications often work more quickly than CBT. Depending on the type of drug, changes in anxiety can be observed in as little as an hour for treatment with anti-anxiety medications, and in as little as two to four weeks for treatment with antidepressant medications. Typically, CBT takes several weeks to months before significant changes take place. 药物通常比认知行为疗法起效更快。根据药物类型，使用抗焦虑药物治疗时，焦虑症状可能在短短一小时内有所改善；使用抗抑郁药物治疗时，通常在两到四周内可见变化。通常，认知行为疗法需要数周到数月时间才能出现显著变化。
Medications are often less expensive in the short term. Visits to your doctor can be infrequent once a stable dosage is reached. At that point, the only cost is the medication itself. In contrast, CBT usually requires regular visits to a therapist throughout the treatment and therefore can be costly, especially if you have limited coverage through your health insurance. 短期来看，药物治疗通常费用较低。一旦剂量稳定，医生的复诊次数可以减少，此时唯一的费用就是药物本身。相比之下，认知行为疗法通常需要在整个治疗过程中定期见治疗师，因此费用较高，尤其是当你的健康保险覆盖有限时。
Disadvantages of Medications Compared with CBT 与认知行为疗法相比，药物治疗的缺点
Anxiety is more likely to return after stopping medication than after stopping CBT. In other words, the effects of CBT are often longer lasting. 停止用药后，焦虑症更容易复发，而停止认知行为疗法（CBT）后复发的可能性较小。换句话说，CBT 的效果通常更持久。
Medication may be more expensive than CBT over the long term. Because medication is typically used for a longer period (often years), the costs are likely to add up to more than the cost of CBT, which generally lasts only several months. 从长期来看，药物治疗可能比 CBT 更昂贵。因为药物通常需要使用较长时间（通常是几年），其费用可能累计超过通常只持续几个月的 CBT 费用。
Many people experience side effects when taking medications. Although these are usually manageable and improve after the first few weeks, some people experience more severe side effects, making treatment with medication unpleasant or impossible. The main side effect of CBT is an increase in anxiety during exposure to feared situations, and this anxiety resolves quickly. 许多人在服用药物时会经历副作用。虽然这些副作用通常是可控的，并且在最初几周后会有所改善，但有些人会经历更严重的副作用，使得药物治疗变得不愉快或无法继续。CBT 的主要副作用是在暴露于恐惧情境时焦虑增加，但这种焦虑会很快消退。
Medications for social anxiety may interact with alcohol and with other medications. They may also cause problems in people who have certain medical illnesses. CBT does not interact in the same ways with alcohol, medications, or medical illnesses. 社交焦虑的药物可能会与酒精和其他药物发生相互作用，也可能对患有某些疾病的人造成问题。CBT 则不会以同样的方式与酒精、药物或疾病发生相互作用。
Some medications are difficult to stop taking because they may cause uncomfortable symptoms during discontinuation. This is particularly a problem with anti-anxiety medications, as well as with a few specific antidepressants. Medications with the potential for dependence should be discontinued slowly, under supervision from your doctor. In contrast, physical dependence and withdrawal problems are not associated with CBT. 有些药物难以停止服用，因为停药期间可能会引起不适症状。这在抗焦虑药物以及某些特定抗抑郁药中尤为突出。具有依赖潜力的药物应在医生的监督下缓慢停用。相比之下，认知行为疗法（CBT）不会引起身体依赖和戒断问题。
Some medications (in particular, monoamine oxidase inhibitors) require a restricted diet. CBT does not require any food restrictions. 某些药物（尤其是单胺氧化酶抑制剂）需要限制饮食。认知行为疗法（CBT）则不需要任何饮食限制。
Many medications must be either used with caution or avoided completely during pregnancy or if you are breastfeeding. CBT can be used safely in either of these situations. 许多药物在怀孕期间或哺乳期必须谨慎使用或完全避免。认知行为疗法（CBT）在这两种情况下均可安全使用。
In deciding whether to try medications, you should consult with your doctor. Keep in mind, however, that your doctor’s advice regarding this issue is likely to be influenced by his or her own expertise and preferences (for example, family doctors are often much less familiar with research on CBT than with medication options). In reality, it’s very difficult to predict who is most likely to respond to CBT or vs. medication, vs. a combination of these two approaches. We generally recommend that people try CBT initially, if it is available, because the benefits tend to be longer lasting than those of medication. In cases where CBT alone is not effective or is only partially effective, the addition of medications can be considered. 在决定是否尝试药物治疗时，你应当咨询医生。然而，请记住，医生在这个问题上的建议很可能会受到其自身专业知识和偏好的影响（例如，家庭医生通常对认知行为疗法（CBT）的研究了解远不如对药物选择的了解）。实际上，很难预测谁更可能对认知行为疗法、药物治疗或这两者的结合产生反应。我们通常建议人们如果条件允许，首先尝试认知行为疗法，因为其益处往往比药物治疗更持久。在认知行为疗法单独使用无效或仅部分有效的情况下，可以考虑添加药物治疗。
CHOOSING AMONG MEDICATIONS 药物选择
If you decide to try medications, there are two general classes of drugs that have been found to be effective for social anxiety: antidepressant and anti-anxiety medications. There is also evidence that beta-adrenergic blockers (also called “beta-blockers”) may help with focused performance fears (for example, fears of public speaking), as well as some preliminary research supporting the use of certain anticonvulsant medications (these are drugs that are usually used to treat seizures). We will discuss each of these approaches in this chapter, and we will also review what is known about the use of herbal remedies for treating social anxiety. 如果你决定尝试药物治疗，有两类药物被发现对社交焦虑有效：抗抑郁药和抗焦虑药。还有证据表明，β-肾上腺素能阻滞剂（也称为“β阻滞剂”）可能有助于针对特定表现的恐惧（例如，公众演讲恐惧），以及一些初步研究支持使用某些抗惊厥药物（这些药物通常用于治疗癫痫）。我们将在本章中讨论这些方法，并回顾关于使用草药治疗社交焦虑的相关知识。
When selecting among these medications, you and your doctor should take into account the following factors: 在选择这些药物时，你和你的医生应考虑以下因素：
Research findings on available medications. Treatment guidelines recently published by the Canadian Psychiatric Association recommended antidepressant treatments as the first medications to try for social anxiety disorder, based on the most recent research (Swinson et al. 2006). In particular, venlafaxine, escitalopram, fluvoxamine, paroxetine, and sertraline had been investigated in the largest number of studies at the time the guidelines were published. These medications are discussed later in this chapter. 关于现有药物的研究发现。加拿大精神病学会最近发布的治疗指南基于最新研究（Swinson 等，2006 年），推荐抗抑郁药作为社交焦虑症的首选药物。特别是，指南发布时，文拉法辛、艾司西酞普兰、氟伏沙明、帕罗西汀和舍曲林在最多的研究中被调查。这些药物将在本章后面讨论。
Your particular social anxiety symptoms. For example, although people with focused performance fears (like public speaking or performing music) may benefit from treatment with beta-blockers, people with more generalized forms of social anxiety tend not to benefit from these medications. 您具体的社交焦虑症状。例如，虽然有针对性表演恐惧（如公开演讲或音乐表演）的人可能从β受体阻滞剂治疗中受益，但患有更广泛形式社交焦虑的人通常不会从这些药物中获益。
Side effect profile of the medication. For instance, if you’re already struggling with your weight, you might want to choose a medication for which weight gain is not a likely side effect. 药物的副作用特征。例如，如果您已经在体重方面有困扰，您可能会选择一种不太可能导致体重增加的药物。
Previous response to medications. If you or a family member has previously responded to a particular medication, that drug might be a good option for you to try now. On the other hand, if there is a drug that didn’t work for you in the past (despite a long enough trial at an adequate dosage), this might be a time to try something new. 之前对药物的反应。如果您或您的家人之前对某种药物有过良好反应，那么现在尝试该药物可能是一个不错的选择。另一方面，如果某种药物在过去（经过足够长时间且剂量适当的试用）对您无效，那么现在可能是尝试新药的时候了。
Additional psychological disorders that are present. For example, if you are experiencing depression, it might make more sense to try an antidepressant than an anti-anxiety drug. The antidepressant would likely lead to an improvement in both problems. 存在的其他心理障碍。例如，如果您正经历抑郁症，尝试抗抑郁药可能比抗焦虑药更合适。抗抑郁药很可能同时改善这两种问题。
Cost. Older medications tend to be less expensive than newer medications, often because older drugs are available in generic forms. 费用。老药通常比新药便宜，往往是因为老药有仿制药形式。
Interactions with other medications and herbal remedies. If you are already taking certain medications or herbal products, you should choose a drug that will not interact with the products you are already taking. 与其他药物和草药的相互作用。如果您已经在服用某些药物或草药产品，应选择不会与您现有药物发生相互作用的药物。
Interactions with certain foods. Medications such as phenelzine can be dangerous if taken with certain foods (those containing tyramine, such as aged cheese and draft beer). Other medications may also interact with foods. For example, grapefruit juice appears to decrease the metabolism of certain selective serotonin reuptake inhibitors (such as sertraline and fluvoxamine), increasing the likelihood that they will accumulate in the body. 与某些食物的相互作用。像苯乙肼这样的药物如果与某些食物（含有酪胺的食物，如陈年奶酪和生啤酒）一起服用可能会有危险。其他药物也可能与食物发生相互作用。例如，葡萄柚汁似乎会降低某些选择性 5-羟色胺再摄取抑制剂（如舍曲林和氟伏沙明）的代谢，增加它们在体内积累的可能性。
Interactions with medical conditions. If you have a particular medical condition (for example, high blood pressure), you should choose a drug that will not worsen the symptoms of your illness. 与医疗状况的相互作用。如果你有某种特定的医疗状况（例如高血压），你应选择不会加重病情症状的药物。
Substance-use issues. If you enjoy drinking alcohol or if you use other drugs, you should choose a medication that is unlikely to interact with these substances. 物质使用问题。如果你喜欢饮酒或使用其他药物，应选择不太可能与这些物质发生相互作用的药物。
Discontinuation issues. Medications that leave the body quickly (in other words, those with a short half-life) are more likely to cause withdrawal symptoms and are often harder to discontinue. Therefore, drugs with a longer half-life are usually easier to discontinue. If you and/or your doctor are concerned about your ability to discontinue a medication, this should be factored into your decision regarding which drug to take. (The term balf-life refers to the time that it takes for half of the amount of drug in your body 停药问题。那些在体内代谢迅速的药物（换句话说，半衰期短的药物）更容易引起戒断症状，且通常更难停用。因此，半衰期较长的药物通常更容易停用。如果你和/或你的医生担心你停药的能力，这应当被纳入你选择服用哪种药物的决策中。（半衰期一词指的是体内药物含量减少一半所需的时间。
to be metabolized or broken down. For example, a drug with a half-life of twelve hours would be 50 percent broken down in twelve hours and 75 percent broken down after another twelve hours. Drugs with a longer halflife are broken down more slowly, giving the body time to adjust to stopping the drug). 例如，半衰期为十二小时的药物，在十二小时后会被代谢掉 50%，再过十二小时后会被代谢掉 75%。半衰期较长的药物代谢较慢，给身体留出时间适应停药）。
STAGES IN MEDICATION TREATMENT 药物治疗的阶段
Treatment with medication involves the following five different stages: 药物治疗包括以下五个不同阶段：
The first stage is the assessment. During this phase, your doctor will ask you the necessary questions to help choose the best medication for your needs. 第一阶段是评估。在此阶段，医生会问您必要的问题，以帮助选择最适合您需求的药物。
The second stage is initiation of the drug. In most cases, medications are started at relatively low dosages to give your body a chance to adapt gradually to the new drug. 第二阶段是药物启动。在大多数情况下，药物会以相对较低的剂量开始服用，以使您的身体有机会逐渐适应新药。
The third stage is dose escalation. During this stage of treatment, the dosage is gradually increased until the individual’s symptoms start to improve. The goal of dose escalation is to find the lowest dosage that is effective for a particular person. Throughout the process, care is taken to minimize any side effects that may be present. 第三阶段是剂量递增。在治疗的这一阶段，剂量会逐渐增加，直到个体的症状开始改善。剂量递增的目标是找到对特定人有效的最低剂量。在整个过程中，会注意尽量减少可能出现的副作用。
The fourth stage is called maintenance. During maintenance, the individual continues to take the medication for an extended period of time. For anti depressants, it is usually recommended that treatment continue for at least a year, minimizing the chances of symptoms returning following discontinuation. 第四阶段称为维持期。在维持期，个体会继续服用药物较长时间。对于抗抑郁药，通常建议治疗至少持续一年，以减少停药后症状复发的可能性。
The fifth and final stage of medication treatment is discontinuation. Some time after a person has improved on a medication, the individual may be encouraged to decrease the amount of the medication to assess whether he or she is ready either to lower the dosage or to stop the medication completely. If a person is also receiving CBT, it may be helpful to have regular CBT sessions during the discontinuation phase. In some cases, your doctor may recommend that you continue to take a medication that is working for you. 药物治疗的第五个也是最后一个阶段是停药。在患者服用药物后症状有所改善的一段时间后，医生可能会建议患者减少药物剂量，以评估其是否准备好降低剂量或完全停止用药。如果患者同时接受认知行为疗法（CBT），在停药阶段定期进行 CBT 治疗可能会有所帮助。在某些情况下，医生可能建议您继续服用对您有效的药物。
TREATMENT WITH ANTIDEPRESSANTS 抗抑郁药治疗
Antidepressants are the most frequently recommended medications for social anxiety. These drugs are called “antidepressants” because they were initially marketed for treating 抗抑郁药是社交焦虑最常推荐的药物。这些药物被称为“抗抑郁药”，因为它们最初是作为治疗
depression. However, don’t be fooled by their name. These drugs are useful for a wide range of psychological problems, including social anxiety disorder. In fact, they appear to work for this problem regardless of whether an individual is depressed. There are several classes of antidepressant medications that are thought to be useful for treating social phobia. Each of these is described in this section. In addition, a table of recommended dosages is included at the end of this section. 抑郁症。然而，不要被它们的名称所迷惑。这些药物对多种心理问题都有用，包括社交焦虑症。事实上，无论个体是否抑郁，这些药物似乎都能对该问题起作用。有几类抗抑郁药被认为对治疗社交恐惧症有用。本节将介绍每一类药物。此外，本节末尾还附有推荐剂量的表格。
Note that we also indicate which of these drugs is officially approved by the United States Food and Drug Administration (FDA). Although FDA approval typically indicates that a medication is safe and effective when used properly, there are many medications that are safe and effective for social anxiety that are not approved by the FDA or regulatory bodies in other countries. This is because it is very expensive and time consuming for pharmaceutical companies to obtain official FDA indications for their products, and they therefore tend to limit the number of problems for which they apply for approval. 请注意，我们还会指出哪些药物已获得美国食品药品监督管理局（FDA）的正式批准。虽然 FDA 批准通常表明药物在正确使用时是安全有效的，但许多对社交焦虑安全有效的药物并未获得 FDA 或其他国家监管机构的批准。这是因为制药公司获得 FDA 正式适应症认证的费用高昂且耗时，因此他们往往限制申请批准的适应症数量。
SSRIs are often the first choice for treating social phobia. In fact, the SSRI paroxetine (Paxil) was the first drug to receive an FDA indication for treatment of social anxiety disorder. Paroxetine is also available in a continuous release formula, marketed under the name Paxil CR. Another SSRI that is FDA approved is sertraline (Zoloft). Although only two SSRIs are officially approved for treating social anxiety disorder, there is no evidence that either of these medications works any better or worse than most other SSRIs for this problem. In practice, any of the SSRIs can be used to treat problems with social anxiety. Other SSRIs that have been found to be effective for social anxiety disorder include fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro in the United States, Cipralex in Canada). Fluoxetine (Prozac) has been found to be effective in some studies, but not others (Hedges et al. 2007; Swinson et al. 2006). 选择性血清素再摄取抑制剂（SSRIs）通常是治疗社交恐惧症的首选药物。事实上，SSRI 帕罗西汀（Paxil）是首个获得美国食品药品监督管理局（FDA）批准用于治疗社交焦虑障碍的药物。帕罗西汀还有一种缓释配方，名为 Paxil CR。另一种获得 FDA 批准的 SSRI 是舍曲林（Zoloft）。尽管只有两种 SSRIs 被正式批准用于治疗社交焦虑障碍，但没有证据表明这两种药物在治疗该问题上比其他大多数 SSRIs 效果更好或更差。在实际应用中，任何 SSRIs 都可以用于治疗社交焦虑问题。其他被发现对社交焦虑障碍有效的 SSRIs 包括氟伏沙明（Luvox）、西酞普兰（Celexa）和艾司西酞普兰（在美国称为 Lexapro，在加拿大称为 Cipralex）。氟西汀（Prozac）在一些研究中被发现有效，但在其他研究中则未见明显效果（Hedges 等，2007；Swinson 等，2006）。
Although the side effects vary slightly across the SSRIs, some of the most common ones include nausea, diarrhea, headache, sweating, increased anxiety, tremor, sexual dysfunction, weight gain, dry mouth, palpitations, chest pain, dizziness, twitching, constipation, increased appetite, fatigue, thirst, and insomnia. Don’t be discouraged by the long list of side effects. Most people experience only a very small number of these, and some individuals experience no side effects at all. Side effects are generally quite manageable. They tend to be worse during the first few weeks of treatment and can be managed by keeping the dosage low until the person becomes used to the medication. Certain side effects (for example, medication-related weight gain and sexual dysfunction) tend not to decrease over time, unless the drug is stopped or the dosage is decreased. 虽然不同的选择性 5-羟色胺再摄取抑制剂（SSRIs）副作用略有不同，但一些最常见的副作用包括恶心、腹泻、头痛、出汗、焦虑加重、震颤、性功能障碍、体重增加、口干、心悸、胸痛、头晕、抽搐、便秘、食欲增加、疲劳、口渴和失眠。不要因为这长长的副作用清单而气馁。大多数人只会经历其中极少数的副作用，有些人甚至完全没有副作用。副作用通常是可以很好控制的。它们往往在治疗的最初几周较为严重，可以通过保持低剂量直到患者适应药物来进行管理。某些副作用（例如药物相关的体重增加和性功能障碍）通常不会随着时间的推移而减轻，除非停止用药或减少剂量。
SSRIs typically take two to four weeks before they start working. They are believed to work by altering serotonin levels in the brain. Serotonin is an example of a neurotransmitter, which is a chemical involved in the transmission of information from one brain cell to the SSRIs 通常需要两到四周才能开始发挥作用。它们被认为通过改变大脑中的血清素水平来起作用。血清素是一种神经递质的例子，神经递质是一种参与从一个脑细胞向另一个脑细胞传递信息的化学物质。
next. Serotonin is thought to be involved in the regulation of emotion and other aspects of psychological functioning. 下一步。血清素被认为参与情绪调节及其他心理功能方面。
Most SSRIs are relatively easy to discontinue, although paroxetine is more likely than the others to cause withdrawal symptoms during discontinuation because it is metabolized more quickly by the body. Therefore, paroxetine should be stopped more gradually than the other SSRIs. Common withdrawal symptoms during discontinuation of paroxetine include sleep disturbances, agitation, tremor, anxiety, nausea, diarrhea, dry mouth, vomiting, sexual disturbances, and sweating. 大多数选择性血清素再摄取抑制剂（SSRIs）相对容易停用，尽管帕罗西汀比其他药物更容易在停药期间引起戒断症状，因为它在体内代谢更快。因此，帕罗西汀应比其他 SSRIs 更逐渐停用。停用帕罗西汀时常见的戒断症状包括睡眠障碍、激动、震颤、焦虑、恶心、腹泻、口干、呕吐、性功能障碍和出汗。
Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) 选择性血清素和去甲肾上腺素再摄取抑制剂（SNRIs）
Venlafaxine XR (Effexor XR) is currently the only available SNRI that has been found in large studies to be effective for treating social anxiety disorder-in fact, it is approved by the FDA for this purpose (the “XR” stands for “extended release”). Unlike the SSRIs, venlafaxine acts both on the serotonin and norepinephrine neurotransmitter systems, both of which appear to be related to problems with anxiety and depression. A number of well-controlled studies suggest that venlafaxine is useful for treating social phobia (Swinson et al. 2006), although, like the SSRIs, it takes several weeks to have an effect. The most commonly reported side effects of venlafaxine include sweating, nausea, constipation, loss of appetite, vomiting, sleepiness, dry mouth, dizziness, nervousness, increased anxiety, and sexual disturbances. When discontinued too quickly, the most common withdrawal symptoms include: sleep disturbances, dizziness, nervousness, dry mouth, anxiety, nausea, headache, sweating, and sexual problems. Duloxetine (Cymbalta) is another recently introduced SNRI that has been shown to be useful for depression and some forms of anxiety. However, with the exception of published case studies (Crippa et al. 2007), this drug has not yet been studied for social anxiety, and it is too early to recommend it for this problem. 文拉法辛缓释片（Effexor XR）目前是唯一在大型研究中被发现对治疗社交焦虑症有效的 SNRI 药物——事实上，它已获得 FDA 批准用于此目的（“XR”代表“缓释”）。与 SSRIs 不同，文拉法辛作用于血清素和去甲肾上腺素两种神经递质系统，这两者似乎都与焦虑和抑郁问题有关。多项严格控制的研究表明，文拉法辛对治疗社交恐惧症有用（Swinson 等，2006），尽管像 SSRIs 一样，它需要数周时间才能发挥效果。文拉法辛最常见的副作用包括出汗、恶心、便秘、食欲减退、呕吐、嗜睡、口干、头晕、紧张、焦虑加重和性功能障碍。若停药过快，最常见的戒断症状包括：睡眠障碍、头晕、紧张、口干、焦虑、恶心、头痛、出汗和性功能问题。度洛西汀（Cymbalta）是另一种新近上市的 SNRI，已被证明对抑郁症和某些类型的焦虑症有疗效。 然而，除了已发表的病例研究（Crippa 等，2007）之外，这种药物尚未用于社交焦虑的研究，目前还为时过早，无法推荐其用于此类问题。
Currently, the only NaSSA available is a drug called mirtazapine (Remeron). Like the SNRIs, mirtazapine works by affecting levels of both norepinephrine and serotonin. This drug is newer than the other antidepressants discussed so far. Nevertheless, some initial studies suggest that mirtazapine is an effective treatment for social anxiety disorder (Muehlbacher et al. 2005; Van Veen, Van Vliet, and Westenberg 2002). The most common side effects of mirtazapine include sleepiness, weight gain, dry mouth, constipation, and blurred vision. 目前，唯一可用的 NaSSA 药物是米氮平（Remeron）。与 SNRIs 类似，米氮平通过影响去甲肾上腺素和血清素的水平起作用。这种药物比迄今为止讨论的其他抗抑郁药更新。然而，一些初步研究表明，米氮平是治疗社交焦虑障碍的有效药物（Muehlbacher 等，2005；Van Veen、Van Vliet 和 Westenberg，2002）。米氮平最常见的副作用包括嗜睡、体重增加、口干、便秘和视力模糊。
MAOIs affect three neurotransmitter systems in the brain: serotonin, norepinephrine, and dopamine. The most studied MAOI for treating social phobia is phenelzine (Nardil). This drug has consistently been found to alleviate the symptoms of social phobia (Swinson et al. 2006). Like the other antidepressants, phenelzine takes several weeks to have a therapeutic effect. MAOIs 影响大脑中的三种神经递质系统：血清素、去甲肾上腺素和多巴胺。用于治疗社交恐惧症的研究最多的 MAOI 是苯乙肼（Nardil）。研究发现，这种药物能持续缓解社交恐惧症的症状（Swinson 等，2006 年）。与其他抗抑郁药一样，苯乙肼需要数周时间才能产生治疗效果。
Despite their effectiveness, MAOIs are rarely used in clinical practice because of necessary dietary restrictions and because the side effects tend to be worse than those from other medications. When taking MAOIs, you must avoid foods containing a substance called tyramine. These include aged cheeses, meat extracts, overripe bananas, sausage, tofu, soy sauce, draft beer, and many other foods. MAOIs are also dangerous when combined with certain other medications, including SSRIs. The most commonly reported side effects of MAOIs include dizziness, headache, drowsiness, sleep disturbances, fatigue, weakness, tremors, twitching, constipation, dry mouth, weight gain, low blood pressure, and sexual disturbances. 尽管效果显著，MAOIs 在临床上很少使用，因为需要严格的饮食限制，而且其副作用往往比其他药物更严重。服用 MAOIs 时，必须避免含有一种叫做酪胺的物质的食物。这些食物包括陈年奶酪、肉提取物、过熟的香蕉、香肠、豆腐、酱油、鲜啤酒以及许多其他食物。MAOIs 与某些其他药物（包括 SSRIs）合用时也很危险。MAOIs 最常见的副作用包括头晕、头痛、嗜睡、睡眠障碍、疲劳、虚弱、震颤、抽搐、便秘、口干、体重增加、低血压和性功能障碍。
Reversible Inhibitors of Monoamine Oxidase (RIMAs) 可逆性单胺氧化酶抑制剂（RIMAs）
Reversible inhibitors of monoamine oxidase are a type of MAOI that tend to have fewer side effects than traditional MAOIs. In addition, they are less likely than traditional MAOIs to interact with other medications and with foods containing tyramine. The only RIMA that is available is moclobemide (Manerix in Canada, Aurorix in several other countries), though this drug is not currently marketed in the United States. Findings from studies on moclobemide for social anxiety disorder have been mixed. Early studies found that this medication was helpful for treating social anxiety, whereas more recent studies have found only modest effects. In some studies, moclobemide was no better than placebo (Swinson et al. 2006). 单胺氧化酶可逆抑制剂（RIMA）是一类 MAOI，通常比传统 MAOI 副作用更少。此外，它们与其他药物及含有酪胺的食物的相互作用也比传统 MAOI 少。唯一可用的 RIMA 是莫氯贝胺（加拿大称为 Manerix，其他几个国家称为 Aurorix），但该药目前在美国尚未上市。关于莫氯贝胺治疗社交焦虑症的研究结果不一。早期研究发现该药对治疗社交焦虑有帮助，而较新的研究则仅发现其效果有限。在一些研究中，莫氯贝胺的效果并不优于安慰剂（Swinson 等，2006 年）。
The most commonly reported side effects for people taking moclobemide include fatigue, constipation, low blood pressure, decreased sex drive, dry mouth, difficulties ejaculating, insomnia, vertigo, and headache. Like the other antidepressants, moclobemide takes several weeks to have a therapeutic effect. 服用莫氯贝胺最常报告的副作用包括疲劳、便秘、低血压、性欲减退、口干、射精困难、失眠、眩晕和头痛。与其他抗抑郁药一样，莫氯贝胺需要数周时间才能产生治疗效果。
Dose Ranges for Antidepressants in the Treatment of Social Phobia 抗抑郁药治疗社交恐惧症的剂量范围
Generic Name 通用名
Brand Name 品牌名称
Therapeutic Dose Range (mg)* 治疗剂量范围（毫克）*
SSRIs 选择性 5-羟色胺再摄取抑制剂（SSRIs）
citalopram 西酞普兰
Celexa
10-60
escitalopram 艾司西酞普兰
Lexapro/Cipralex 乐友/喜普乐
10-20
fluoxetine 氟西汀
Prozac 百忧解
10-80
fluvoxamine 氟伏沙明
Luvox 乐友
50-300
paroxetine 帕罗西汀
Paxil 帕罗西汀
10-60
paroxetine CR 帕罗西汀控释
Paxil CR 帕罗西汀控释
12.5-75
sertraline 舍曲林
Zoloft 佐洛 ft
50-200
Other Antidepressants 其他抗抑郁药
mirtazapine 米氮平
Remeron 瑞美隆
15-60
moclobemide 莫氯贝胺
Manerix/Aurorix
300-600
phenelzine 苯乙肼
Nardil
45-90
venlafaxine XR 文拉法辛缓释片
Effexor XR
75-375
*Dosages are based, in part, on recommendations by Bezchlibnyk-Butler, Jeffries, and Virani 2007. *剂量部分基于 Bezchlibnyk-Butler、Jeffries 和 Virani 2007 年的建议。
The most frequently prescribed anti-anxiety medications are the benzodiazepines. These are sedatives that include drugs such as clonazepam (Klonapin in the USA; Rivotril in Canada), alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). To date, only clonazepam and alprazolam have been investigated in controlled studies for the treatment of social anxiety disorder (Swinson et al. 2006). Although neither is officially approved by the FDA for treating social anxiety, both of these medications have been found to be useful for this problem. The typical starting dose for alprazolam and clonazepam is .5 mg per day, with a maximum daily dose of 1.5 to 3 mg for alprazolam and 4 mg for clonazepam (Swinson et al. 2006). 最常被处方用于抗焦虑的药物是苯二氮卓类。这些镇静剂包括克隆纳西泮（美国称 Klonapin，加拿大称 Rivotril）、阿普唑仑（Xanax）、地西泮（Valium）和劳拉西泮（Ativan）等药物。迄今为止，只有克隆纳西泮和阿普唑仑在控制性研究中被用于社交焦虑障碍的治疗（Swinson 等，2006 年）。尽管这两种药物均未获得美国食品药品监督管理局（FDA）正式批准用于治疗社交焦虑，但它们都被发现对该问题有一定疗效。阿普唑仑和克隆纳西泮的典型起始剂量为每天 0.5 毫克，阿普唑仑的最大日剂量为 1.5 至 3 毫克，克隆纳西泮的最大日剂量为 4 毫克（Swinson 等，2006 年）。
When taken on a regular basis, these medications tend to be effective for treating social anxiety. The most common side effects include drowsiness, lightheadedness, depression, headache, confusion, dizziness, unsteadiness, insomnia, and nervousness. 当定期服用时，这些药物通常对治疗社交焦虑有效。最常见的副作用包括嗜睡、头晕、抑郁、头痛、意识混乱、眩晕、不稳、失眠和紧张。
These drugs may affect a person’s ability to drive safely and they tend to interact strongly with alcohol. In addition, they should be used with caution by older people because higher dosages have been associated with a greater likelihood of falling. 这些药物可能影响一个人安全驾驶的能力，并且它们往往与酒精产生强烈的相互作用。此外，老年人使用时应谨慎，因为较高剂量与跌倒的可能性增加有关。
There are several advantages to taking benzodiazepines compared with antidepressant medications. First, they work very quickly (within a half hour) and therefore can be used on an “as needed” basis to deal with particularly stressful situations. They also may be used during the first few weeks of antidepressant treatment, while the individual waits for the antidepressant to take effect. In addition, the side effect profile of benzodiazepines is quite different from that of antidepressants, and these drugs may be more easily tolerated by some people. 与抗抑郁药物相比，服用苯二氮卓类药物有几个优点。首先，它们起效非常快（半小时内），因此可以按需使用来应对特别紧张的情况。它们也可以在抗抑郁药物治疗的最初几周使用，帮助个体等待抗抑郁药物发挥作用。此外，苯二氮卓类药物的副作用与抗抑郁药物有很大不同，有些人可能更容易耐受这些药物。
Despite these benefits, benzodiazepines have fallen out of favor in recent years, mostly because they can be difficult to discontinue. Stopping these drugs can cause temporary (but sometimes intense) feelings of anxiety, arousal, and insomnia. In rare cases, abrupt discontinuation can cause seizures. Given that discontinuation from these medications can cause intense anxiety, it is not surprising that some individuals have difficulty stopping these drugs. The symptoms of withdrawal can be minimized by discontinuing these drugs very gradually. Benzodiazepines are a potentially effective option for treating social anxiety, particularly over brief periods. However, they are typically not recommended as a first-line treatment (Swinson et al. 2006). 尽管有这些好处，苯二氮卓类药物近年来已不再受欢迎，主要是因为它们可能难以停用。停用这些药物可能会引起暂时的（但有时非常强烈的）焦虑、兴奋和失眠感。在极少数情况下，突然停药可能会引发癫痫发作。鉴于停用这些药物可能导致强烈的焦虑，不难理解一些人难以停止使用这些药物。通过非常逐渐地停药，可以最大限度地减少戒断症状。苯二氮卓类药物在治疗社交焦虑方面可能是一个有效的选择，尤其是在短期内。然而，它们通常不被推荐作为一线治疗（Swinson 等，2006）。
TREATMENT WITH BETA-ADRENERGIC BLOCKERS β-肾上腺素能受体阻滞剂治疗
Beta-blockers are normally used for treating high blood pressure. In addition, they are effective for decreasing some of the physical symptoms of fear such as palpitations and shakiness. A number of early studies suggest that beta-blockers are useful for managing intense fear in certain performance situations (Hartley et al. 1983; James, Burgoyne, and Savage 1983). In particular, they are often used by actors, musicians, and other performers to manage stage fright. However, beta-blockers are ineffective for treating more generalized forms of social anxiety and shyness. The most commonly used beta-blocker for treating performance fears is propanolol (Inderal). This medication is normally taken in a single dose of 5 to 10 mg , about twenty to thirty minutes before a performance. β受体阻滞剂通常用于治疗高血压。此外，它们对减轻一些恐惧的身体症状如心悸和颤抖也有效。一些早期研究表明，β受体阻滞剂在某些表演情境中管理强烈恐惧方面有用（Hartley 等，1983；James、Burgoyne 和 Savage，1983）。特别是，演员、音乐家和其他表演者常用它们来应对舞台恐惧。然而，β受体阻滞剂对治疗更广泛的社交焦虑和害羞无效。治疗表演恐惧最常用的β受体阻滞剂是普萘洛尔（Inderal）。这种药物通常在表演前约二十到三十分钟服用一次，剂量为 5 到 10 毫克。
ANTICONVULSANTS 抗惊厥药
Anticonvulsants are used to treat seizures, as well as pain, anxiety, and certain mood problems. Recently, there have been a number of preliminary studies finding that certain anticonvulsants such as gabapentin (Neurontin), pregabalin (Lyrica), and topiramate (Topamax) may be useful for treating social anxiety disorder (Swinson et al. 2006). At this point, however, it is too soon to recommend these treatments for social anxiety. Additional research is needed. 抗惊厥药用于治疗癫痫发作，以及疼痛、焦虑和某些情绪问题。最近，有一些初步研究发现某些抗惊厥药如加巴喷丁（Neurontin）、普瑞巴林（Lyrica）和托吡酯（Topamax）可能对治疗社交焦虑症有用（Swinson 等，2006）。然而，目前还为时过早，不能推荐这些治疗方法用于社交焦虑。还需要进一步的研究。
NATURAL AND HERBAL REMEDIES FOR SOCIAL ANXIETY 社交焦虑的天然和草本疗法
In recent years, herbal preparations have become popular for treating a wide range of health problems. For the treatment of anxiety and related problems, commonly used herbal preparations include St.-John’s-wort, kava kava, inositol, Rescue Remedy, and various other products. Generally, there have been very few studies on these products in people with anxiety-based problems, and we are aware of only one study that has specifically tested the effects of an herbal remedy for treating social anxiety disorder (Kobak et al. 2005). In this study, 600 to 1800 mg per day of St.-John’s-wort (also known as hypericum) was compared to an inactive placebo in forty people with social anxiety disorder. No differences were found in the effectiveness of St.-John’s-wort vs. placebo, despite the fact that some studies have found St.-John’s-wort to be an effective treatment for depression. 近年来，草药制剂在治疗各种健康问题方面变得流行。用于治疗焦虑及相关问题的常用草药制剂包括贯叶连翘、卡瓦卡瓦、肌醇、救援花精以及其他各种产品。总体而言，针对这些产品在焦虑相关问题患者中的研究非常少，我们只知道有一项研究专门测试了草药疗法对社交焦虑症的治疗效果（Kobak 等，2005 年）。在这项研究中，每天服用 600 至 1800 毫克贯叶连翘（也称为贯叶金丝桃）与安慰剂在 40 名社交焦虑症患者中进行了比较。尽管有些研究发现贯叶连翘对抑郁症治疗有效，但本研究未发现贯叶连翘与安慰剂在疗效上有差异。
In addition to the lack of studies on the effectiveness of herbal treatments, very little is known about the safety of many of these remedies or the extent to which they interact with conventional medications. Be sure to tell your doctor if you are taking any herbal products, just in case there are any known interactions with medications you may also be taking. 除了缺乏关于草药治疗效果的研究外，对于许多这些疗法的安全性或它们与传统药物相互作用的程度知之甚少。如果你正在服用任何草药产品，一定要告诉你的医生，以防这些草药与您可能正在服用的药物之间存在已知的相互作用。
Although little is known about the effects of herbal treatments on social anxiety, there are a few studies on the use of herbal products for other anxiety problems (Connor and Vaishnavi, in press). Still, more studies are currently under way. In the coming years, additional information regarding the safety, interactions, and effectiveness of these treatments will be available. 尽管对草药治疗社交焦虑的效果知之甚少，但已有一些关于草药产品用于其他焦虑问题的研究（Connor 和 Vaishnavi，待发表）。不过，目前还有更多的研究正在进行中。在未来几年，将会有更多关于这些治疗方法的安全性、相互作用和有效性的资料可供参考。
COMBINING MEDICATIONS 联合用药
Your doctor may recommend combining several medications for treating your social anxiety. In most cases, there is very little research on the benefits of combining different medications. However, one combination that has been studied for the treatment of anxiety is the combination of an antidepressant (for example, paroxetine) with a benzodiazepine (for example, clonazepam). Ideally, both drugs are started at the same time. The benzodiazepine helps to keep the anxiety under control during the first few weeks while the person waits for the antidepressant to start working. Then, once the antidepressant kicks in, the benzodiazepine is discontinued gradually. 您的医生可能会建议结合多种药物来治疗您的社交焦虑。在大多数情况下，关于不同药物联合使用的益处，研究非常有限。然而，有一种用于治疗焦虑的组合药物已经被研究过，那就是抗抑郁药（例如帕罗西汀）与苯二氮卓类药物（例如氯硝西泮）的联合使用。理想情况下，这两种药物应同时开始使用。苯二氮卓类药物有助于在最初几周内控制焦虑，因为此时患者还在等待抗抑郁药发挥作用。然后，一旦抗抑郁药起效，苯二氮卓类药物会逐渐停用。
A limited number of studies have investigated whether it is useful to combine an SSRI with a benzodiazepine. Whereas some studies of anxiety problems other than social phobia suggest that this combination is useful for reducing anxiety symptoms more quickly than an SSRI alone (Pollack et al. 2003), a study of people suffering from social phobia did not find any added benefit of combining medications on the rate of recovery (Seedat and Stein 2004). 有限的研究调查了将选择性 5-羟色胺再摄取抑制剂（SSRI）与苯二氮卓类药物联合使用是否有用。虽然一些针对社交恐惧症以外的焦虑问题的研究表明，这种组合比单独使用 SSRI 更快地减轻焦虑症状（Pollack 等，2003 年），但一项针对社交恐惧症患者的研究并未发现联合用药在恢复速度上有任何额外益处（Seedat 和 Stein，2004 年）。
COMBINING MEDICATION WITH PSYCHOLOGICAL TREATMENTS 药物与心理治疗的联合使用
Studies comparing medications to CBT have generally found both approaches to be very effective for reducing anxiety. In addition, a number of researchers have begun to study the benefits of combining CBT and medications (Antony and Rowa 2008). Overall, there do not appear to be any consistent benefits of combining these treatments. That is, medication, CBT, and a combination of these approaches all tend to be about equally effective on average, based on the available evidence (for instance, Davidson et al. 2004). However, that doesn’t mean that one approach or another is not likely to be more effective for any one person (including you). In other words, it is often the case that some people do best with CBT, some do best with medication, and some do best with a combined treatment. If you decide to try combining CBT with medication, it is helpful if both treatments are delivered by the same person, or if the professionals providing you with CBT and medication are in contact with one another. Treatment is most likely to be helpful when multiple treatments are delivered in a coordinated fashion. 比较药物治疗与认知行为疗法（CBT）的研究普遍发现，这两种方法在减轻焦虑方面都非常有效。此外，许多研究人员开始研究将 CBT 与药物治疗结合的益处（Antony 和 Rowa 2008）。总体来看，结合这两种治疗方法似乎并没有表现出一致的额外好处。也就是说，根据现有证据（例如 Davidson 等人，2004 年），药物治疗、CBT 以及这两者的结合在平均效果上大致相当。然而，这并不意味着某一种方法对某个人（包括你）不会更有效。换句话说，通常有些人通过 CBT 效果最好，有些人通过药物治疗效果最好，还有些人通过结合治疗效果最好。如果你决定尝试将 CBT 与药物治疗结合，最好由同一位专业人员提供这两种治疗，或者提供 CBT 和药物治疗的专业人员之间保持联系。当多种治疗以协调的方式进行时，治疗最有可能取得良好效果。
COMMON QUESTIONS ABOUT MEDICATION 关于药物治疗的常见问题
Question: Is taking medication a sign of weakness? 问题：服用药物是软弱的表现吗？
Answer: Taking medication for social phobia is no more a sign of weakness than taking medication for any other problem, such as physical illnesses like high blood pressure. 回答：服用社交恐惧症的药物并不比服用其他问题的药物（如高血压等身体疾病）更显示出软弱。
Question: What level of improvement can I expect? 问题：我可以期待达到什么程度的改善？
Answer: A small percentage of people obtain no benefit at all from medications for social phobia. Another small group of people obtain almost complete improvement. However, most people with social phobia experience moderate improvements with medications. They tend to feel less anxious overall and are more comfortable in a broader range of situations. However, there may still be areas in which the social anxiety is a problem for them. 回答：一小部分人服用社交恐惧症药物后完全没有效果。另一小部分人几乎获得了完全的改善。然而，大多数社交恐惧症患者服药后会有中等程度的改善。他们整体上会感到焦虑减轻，并且在更广泛的情境中感到更舒适。不过，仍可能存在一些社交焦虑对他们构成问题的领域。
Question: Are medications for social anxiety dangerous? 问题：社交焦虑的药物危险吗？
Answer: When taken as prescribed, medications for social phobia are generally safe. When side effects cause problems, as a rule they are easy to manage by decreasing the dosage or switching to a different drug. 回答：按照处方服用时，社交恐惧症的药物通常是安全的。当副作用引起问题时，通常通过减少剂量或更换药物可以轻松应对。
Question: Is it dangerous for me to stop taking my medication? 问题：我停止服药会有危险吗？
Answer: 回答：
Medications should always be stopped gradually and in close consultation with your doctor. If done properly, discontinuation is generally safe. 药物应始终在医生的密切指导下逐渐停用。如果操作得当，停药通常是安全的。
Question: 问题：
What happens if my medication doesn't work for me? 如果我的药物对我不起作用，会怎样？
Answer: 回答：
If your medication doesn't work, it is important to first make sure you have been taking it for a long enough time and at an adequate dose. If your medication still is not effective despite an appropriate duration and dosage, you may still benefit from trying a different medication or from receiving CBT. 如果你的药物不起作用，首先要确保你已经服用了足够长的时间且剂量适当。如果在适当的时间和剂量下药物仍然无效，你仍然可以尝试换用其他药物或接受认知行为疗法（CBT），这可能会对你有帮助。
Question: 问题：
How long should I try a medication before assuming that it isn't going to work? 我应该尝试一种药物多长时间，才可以假设它不会起作用？
Answer: 回答：
Most antidepressants will start to have an effect within four to six weeks, if not earlier. If you haven't experienced any benefit after eight weeks at a high enough dosage, it may be worth discussing the possibility of trying a different treatment with your doctor. 大多数抗抑郁药会在四到六周内开始产生效果，有时甚至更早。如果在足够高的剂量下服用八周后仍未见任何效果，可能值得与医生讨论尝试其他治疗方案的可能性。
Question: 问题：
If I go off my medication and my anxiety returns, am I likely to benefit again if I resume taking the same medication? 如果我停药后焦虑症状复发，重新服用同样的药物是否仍然有效？
Answer: 回答：
Often, when a previously effective medication is tried for a second time (following a break), it will work again. However, sometimes a particular medication is less effective the second time, in which case a different medication may be prescribed. 通常情况下，之前有效的药物在停药一段时间后再次使用，仍然会起作用。但有时某种药物第二次使用时效果会减弱，这时可能会换用其他药物。
Answer: Medications should always be stopped gradually and in close consultation with your doctor. If done properly, discontinuation is generally safe.
Question: What happens if my medication doesn't work for me?
Answer: If your medication doesn't work, it is important to first make sure you have been taking it for a long enough time and at an adequate dose. If your medication still is not effective despite an appropriate duration and dosage, you may still benefit from trying a different medication or from receiving CBT.
Question: How long should I try a medication before assuming that it isn't going to work?
Answer: Most antidepressants will start to have an effect within four to six weeks, if not earlier. If you haven't experienced any benefit after eight weeks at a high enough dosage, it may be worth discussing the possibility of trying a different treatment with your doctor.
Question: If I go off my medication and my anxiety returns, am I likely to benefit again if I resume taking the same medication?
Answer: Often, when a previously effective medication is tried for a second time (following a break), it will work again. However, sometimes a particular medication is less effective the second time, in which case a different medication may be prescribed.| Answer: | Medications should always be stopped gradually and in close consultation with your doctor. If done properly, discontinuation is generally safe. |
| :--- | :--- |
| Question: | What happens if my medication doesn't work for me? |
| Answer: | If your medication doesn't work, it is important to first make sure you have been taking it for a long enough time and at an adequate dose. If your medication still is not effective despite an appropriate duration and dosage, you may still benefit from trying a different medication or from receiving CBT. |
| Question: | How long should I try a medication before assuming that it isn't going to work? |
| Answer: | Most antidepressants will start to have an effect within four to six weeks, if not earlier. If you haven't experienced any benefit after eight weeks at a high enough dosage, it may be worth discussing the possibility of trying a different treatment with your doctor. |
| Question: | If I go off my medication and my anxiety returns, am I likely to benefit again if I resume taking the same medication? |
| Answer: | Often, when a previously effective medication is tried for a second time (following a break), it will work again. However, sometimes a particular medication is less effective the second time, in which case a different medication may be prescribed. |
In summary, medications can be an effective method of managing severe social anxiety. Certain anti-anxiety medications (for example, clonazepam) and a number of different antidepressants (for instance, paroxetine, venlafaxine) have consistently been shown to help reduce symptoms of social anxiety. If you decide that you would like to try medication, a first step is to contact your family doctor or psychiatrist. Your doctor will be able to recommend a specific medication that is likely to work for you. 总之，药物可以作为管理严重社交焦虑的有效方法。某些抗焦虑药物（例如氯硝西泮）和多种不同的抗抑郁药（例如帕罗西汀、文拉法辛）已被反复证明有助于减轻社交焦虑的症状。如果你决定尝试药物治疗，第一步是联系你的家庭医生或精神科医生。医生能够推荐一种可能对你有效的特定药物。
CHAPTER 6 第 6 章
Changing Your Anxious Thoughts and Expectations 改变你的焦虑思维和期望
The word cognition refers to the ways in which we process information, including experiences such as thought, perception, interpretation, attention, memory, and knowledge. The word cognitive is simply the adjectival form of the term cognition. For example, cognitive science is the science concerned with the ways in which we think. Cognitive therapy is a type of psychotherapy that is designed to alter negative and unrealistic beliefs, thoughts, and interpretations. 认知一词指的是我们处理信息的方式，包括思维、感知、解释、注意力、记忆和知识等体验。认知的形容词形式就是认知的，即 cognitive。例如，认知科学是研究我们思考方式的科学。认知疗法是一种旨在改变消极和不现实信念、思维和解释的心理治疗方法。
This chapter provides an overview of strategies that have been shown to be useful for decreasing social anxiety by changing negative or unrealistic patterns of thinking. Many of the cognitive techniques and principles discussed in this book have been presented and expanded upon elsewhere by authors such as Aaron T. Beck (Beck, Emery, and Greenberg 1985), David Burns (1999), David M. Clark (Clark and Wells 1995), Richard Heimberg (Heimberg and Becker 2002), Christine Padesky (Greenberger and Padesky 1995), and others. Over the years, strategies similar to those discussed in this chapter have been adopted by the majority of therapists who practice cognitive therapy. 本章概述了通过改变消极或不切实际的思维模式来减少社交焦虑的有效策略。本书中讨论的许多认知技巧和原则，已由 Aaron T. Beck（Beck、Emery 和 Greenberg 1985 年）、David Burns（1999 年）、David M. Clark（Clark 和 Wells 1995 年）、Richard Heimberg（Heimberg 和 Becker 2002 年）、Christine Padesky（Greenberger 和 Padesky 1995 年）等作者在其他著作中提出并加以扩展。多年来，类似本章所述的策略已被大多数从事认知疗法的治疗师采纳。
THE ORIGINS OF COGNITIVE THERAPY 认知疗法的起源
Cognitive therapy was proposed in the 1960s and 1970s as an alternative to traditional psychodynamic psychotheraties, which were the most prevalent forms of therapy at the time. The original (and most influential), form of psychodynamic psychotherapy is psychoanalysis, which Sigmund Freud developed in the early 1900s. Psychodynamic psychotherapies, 认知疗法是在 20 世纪 60 至 70 年代提出的，作为当时最流行的传统心理动力学心理治疗的替代方案。心理动力学心理治疗中最早且最具影响力的形式是精神分析，由西格蒙德·弗洛伊德在 20 世纪初创立。心理动力学心理治疗，
including psychoanalysis, are concerned with helping individuals understand deep-rooted unconscious conflicts that are presumed to cause or contribute to their psychological problems. For example, Freud proposed that depression can occur as a response to having unconscious aggressive thoughts or feelings toward a loved one. Because such feelings are viewed as unacceptable by the individual, he or she is very motivated to keep such thoughts and feelings outside of conscious awareness. According to Freud, rather than allowing the aggressive thoughts to surface, the individual may turn those angry feelings inward, leading to feelings of self-hatred and worthlessness, which are often features of depression. 包括精神分析在内，旨在帮助个体理解被认为导致或促成其心理问题的根深蒂固的无意识冲突。例如，弗洛伊德提出，抑郁可能是对无意识中对亲人抱有攻击性想法或情感的反应。由于个体将这种情感视为不可接受，他或她非常努力地将这些想法和情感排除在意识之外。根据弗洛伊德的观点，个体可能不会让这些攻击性想法浮现，而是将愤怒的情感转向内心，导致自我憎恨和无价值感，这些通常是抑郁的特征。
There are many newer forms of psychodynamic therapy (most psychodynamic psychotherapists no longer accept all of Freud’s ideas), though the focus of these treatments often remains on recounting early childhood experiences, interpreting unconscious experience (such as dreams), and helping individuals to understand the unconscious motivations for their behavior. Although psychodynamic psychotherapies remain popular, they have gradually lost ground to other forms of therapy, including cognitive and behavioral therapies. Some reasons for the decline of psychodynamic psychotherapies include the relative lack of research supporting many of the underlying theoretical assumptions, as well as a lack of research demonstrating the effectiveness of this form of treatment for many specific problems, including social anxiety. 有许多更新的心理动力学治疗形式（大多数心理动力学心理治疗师不再接受弗洛伊德的所有观点），尽管这些治疗的重点通常仍然是回顾早期童年经历、解释无意识体验（如梦境），并帮助个体理解其行为背后的无意识动机。尽管心理动力学心理治疗仍然流行，但它们逐渐被包括认知和行为疗法在内的其他治疗形式所取代。心理动力学心理治疗衰落的原因之一是缺乏支持许多基本理论假设的研究，以及缺乏证明这种治疗形式对许多具体问题（包括社交焦虑）有效的研究。
Despite these criticisms, psychoanalysis and the psychodynamic psychotherapies have made considerable contributions to the understanding and treatment of psychological problems. For example, these were the first treatments based on the assumption that simply talking to another person can lead to psychological changes. In addition, these treatments highlighted the importance of nonconscious information processing. Although there is little evidence to prove the existence of many of the unconscious motivations proposed by Freud, there is evidence that suggests people are frequently unaware of the perceptions and interpretations that contribute to their understanding of their environment. Finally, although many specific aspects of his theory were probably misguided, Freud highlighted the importance of early experience in determining psychological functioning later in life. 尽管存在这些批评，精神分析和心理动力学心理治疗在理解和治疗心理问题方面做出了重大贡献。例如，这些是基于这样一种假设的首批治疗方法：仅仅与他人交谈就能带来心理上的变化。此外，这些治疗强调了无意识信息处理的重要性。尽管几乎没有证据证明弗洛伊德提出的许多无意识动机的存在，但有证据表明，人们经常对那些影响他们理解环境的感知和解释毫无察觉。最后，尽管他理论中的许多具体方面可能是错误的，弗洛伊德强调了早期经历在决定后期心理功能中的重要性。
The Birth of Cognitive Therapy 认知疗法的诞生
In the 1960s and 1970s, a number of psychologists and psychiatrists, disenchanted with psychodynamic psychotherapies, began to explore other ways of helping their patients and clients. Working independently, psychiatrist Aaron Beck (1963; 1964; 1967; 1976) and psychologists Albert Ellis (1962; 1989) and Donald Meichenbaum (1977) each developed new forms of therapy based on the premise that people’s difficulties with depression, anxiety, anger, and related problems stem from the ways in which they think about themselves, their environment, and the future. 在 20 世纪 60 年代和 70 年代，一些对心理动力学心理治疗感到失望的心理学家和精神科医生开始探索帮助患者和客户的其他方法。精神科医生亚伦·贝克（Aaron Beck，1963；1964；1967；1976）和心理学家阿尔伯特·埃利斯（Albert Ellis，1962；1989）及唐纳德·迈肯鲍姆（Donald Meichenbaum，1977）各自独立工作，开发了基于这样一个前提的新型治疗方法：人们在抑郁、焦虑、愤怒及相关问题上的困难，源于他们对自己、环境和未来的思考方式。
For example, fear was assumed to stem from a belief that a particular situation was threatening or dangerous. Beck, Ellis, and Meichenbaum each developed treatments 例如，恐惧被认为源于相信某种特定情境具有威胁性或危险性。贝克、埃利斯和迈肯鲍姆各自开发了相应的治疗方法
designed to help individuals recognize how their beliefs and assumptions contribute to their negative emotions, and to overcome psychological suffering by changing these negative thoughts. Ellis called his form of treatment rational emotive therapy and later renamed it rational emotive behavior therapy (REBT, 1993). Meichenbaum referred to his form of treatment as cognitive-behavior modification (CBM). It was Aaron Beck, however, who first used the term cognitive therapy to describe his treatment. Each of these three new treatments was developed at about the same time, and they were quite similar with respect to their underlying assumptions and some of the treatment strategies used. 旨在帮助个体认识到他们的信念和假设如何导致负面情绪，并通过改变这些负面思维来克服心理痛苦。埃利斯称他的治疗方法为理性情绪疗法，后来改名为理性情绪行为疗法（REBT，1993 年）。迈肯鲍姆则称他的治疗方法为认知行为矫正（CBM）。然而，最早使用“认知疗法”这一术语来描述其治疗方法的是亚伦·贝克。这三种新疗法大约在同一时期发展起来，在其基本假设和部分治疗策略上相当相似。
Over the years, Beck’s form of treatment has become more popular and prominent than either Ellis’s or Meichenbaum’s approaches. Furthermore, Beck’s cognitive therapy has been subjected to more rigorous study than either REBT or CBM for the treatment of social anxiety. Therefore, the methods discussed in this chapter are based on those proposed by Beck and his collaborators, as well as others who adapted and expanded upon Beck’s methods for treating social anxiety and related problems. 多年来，贝克的治疗方法比埃利斯或迈肯鲍姆的方法更受欢迎和重视。此外，贝克的认知疗法在治疗社交焦虑方面所接受的严格研究也多于 REBT 或 CBM。因此，本章讨论的方法基于贝克及其合作者提出的方法，以及其他适应和扩展贝克方法以治疗社交焦虑及相关问题的研究成果。
ASSUMPTIONS OF COGNITIVE THERAPY FOR SOCIAL ANXIETY 认知疗法对社交焦虑的假设
Here are some of the basic assumptions of cognitive therapy, particularly as related to the treatment of shyness, social anxiety, and performance fears. 以下是认知疗法的一些基本假设，特别是与害羞、社交焦虑和表现恐惧的治疗相关的假设。
Negative emotions are caused by negative interpretations and beliefs. People who interpret a given situation in different ways are likely to experience different emotions. For example, imagine that a friend of yours has cancelled a dinner date at the last minute without providing a reason. Below is a list of possible emotional reactions you might have depending on your beliefs and interpretations. 负面情绪是由负面解释和信念引起的。对同一情境有不同解释的人，可能会体验到不同的情绪。例如，假设你的一个朋友在最后一刻取消了晚餐约会，且没有给出理由。下面列出了一些你可能根据自己的信念和解释产生的情绪反应。
Situation: Friend cancels dinner date at the last minute and gives no reason 情境：朋友在最后一刻取消晚餐约会且未说明理由
Interpretation 解释
Emotion 情绪
"My friend has been hurt or is ill." “我的朋友受伤了或者生病了。”
Anxiety or worry 焦虑或担忧
"My friend isn't treating me with the respect I deserve." “我的朋友没有给予我应有的尊重。”
Anger 愤怒
"My friend doesn't care about me." “我的朋友不关心我。”
Sadness 悲伤
"Thank goodness the dinner has been cancelled; I am always so nervous when I have to eat with others." “谢天谢地，晚宴被取消了；每次和别人一起吃饭我总是很紧张。”
Relief 宽慰
"I guess something else came up. Everyone changes plans from time to time, including me." “我想是有别的事情发生了。每个人都会时不时改变计划，包括我自己。”
Neutral 中立
Interpretation Emotion
"My friend has been hurt or is ill." Anxiety or worry
"My friend isn't treating me with the respect I deserve." Anger
"My friend doesn't care about me." Sadness
"Thank goodness the dinner has been cancelled; I am always so nervous when I have to eat with others." Relief
"I guess something else came up. Everyone changes plans from time to time, including me." Neutral| Interpretation | Emotion |
| :--- | :--- |
| "My friend has been hurt or is ill." | Anxiety or worry |
| "My friend isn't treating me with the respect I deserve." | Anger |
| "My friend doesn't care about me." | Sadness |
| "Thank goodness the dinner has been cancelled; I am always so nervous when I have to eat with others." | Relief |
| "I guess something else came up. Everyone changes plans from time to time, including me." | Neutral |
Anxiety and fear result when a person interprets a situation as threatening or dangerous. Although fearful predictions and interpretations are sometimes accurate, they are often exaggerated or inaccurate. Chapter 1 provided a list of thoughts and assumptions that can contribute to social anxiety. These include beliefs about one’s performance (such as, “People will think that I am an idiot”), as well as beliefs about the anxiety itself (for instance, “It’s important for me not to appear anxious in front of other people”). Beliefs such as these help to maintain a person’s anxiety in social and performance situations. 当一个人将某种情境解读为威胁或危险时，就会产生焦虑和恐惧。尽管恐惧的预测和解读有时是准确的，但它们往往被夸大或不准确。第一章列出了可能导致社交焦虑的想法和假设。这些包括关于自己表现的信念（例如，“别人会认为我是个白痴”），以及关于焦虑本身的信念（例如，“我不能在别人面前表现出焦虑，这很重要”）。这样的信念有助于维持一个人在社交和表现情境中的焦虑。
You are the expert regarding your own thoughts and feelings. Unlike some other forms of therapy, which assume that the therapist is the expert, cognitive therapy assumes that the patient and therapist have unique areas of expertise, and the best way to work on a problem is to take advantage of the skills and expertise that each brings to the therapeutic situation. The therapist is assumed to be an expert on the principles and methods of cognitive therapy. The patient is assumed to be an expert regarding his or her own experiences, assumptions, and beliefs. In most cases, the therapist and patient decide together whether a particular belief is exaggerated or unrealistic, and together they generate strategies for changing negative patterns of thinking. 你是自己思想和感受的专家。与某些假设治疗师是专家的其他治疗形式不同，认知疗法假设患者和治疗师各自拥有独特的专业领域，解决问题的最佳方式是利用双方在治疗情境中带来的技能和专业知识。治疗师被认为是认知疗法原理和方法的专家。患者则被认为是自己经历、假设和信念的专家。在大多数情况下，治疗师和患者共同决定某个特定信念是否被夸大或不切实际，并共同制定改变消极思维模式的策略。
The goal of cognitive therapy is to be able to think more realistically rather than simply to think positively. There are occasions where your anxious beliefs are realistic and are quite consistent with the actual threat in a given situation. In these cases, anxiety may be a good thing because it helps you stay on guard and protect yourself from possible danger. For instance, being a bit nervous while interacting with an authority figure (for example, your boss, a police officer) may protect you from seeming overly confident, demanding, or aggressive. Cognitive therapy focuses on situations where your beliefs, predictions, and interpretations are exaggerated when compared with the actual level of danger in the situation. 认知疗法的目标是能够更现实地思考，而不仅仅是积极思考。在某些情况下，你的焦虑信念是现实的，并且与特定情境中的实际威胁相当一致。在这些情况下，焦虑可能是一件好事，因为它帮助你保持警惕，保护自己免受可能的危险。例如，在与权威人物（例如你的老板、警察）互动时感到有些紧张，可能会防止你显得过于自信、强势或咄咄逼人。认知疗法关注的是当你的信念、预测和解释与情境中的实际危险程度相比被夸大时的情况。
People naturally tend to seek out and pay attention to information that confirms their beliefs. In the case of social anxiety, people pay more attention and give more weight to evidence that others are judging them negatively (such as a history of being teased in high school) than to evidence that contradicts the anxious beliefs (for instance, a history of very positive performance appraisals at work). Cognitive therapy aims to help people to consider all the evidence before making any assumptions. 人们天生倾向于寻找并关注能够证实自己信念的信息。在社交焦虑的情况下，人们更关注并更重视那些表明他人对自己持负面评价的证据（例如高中时被嘲笑的经历），而忽视与焦虑信念相矛盾的证据（例如工作中获得的非常积极的绩效评价）。认知疗法旨在帮助人们在做出任何假设之前，全面考虑所有证据。
TYPES OF ANXIOUS THINKING 焦虑思维的类型
Anxious thinking begins and persists when people make incorrect assumptions about what is likely to happen in a given situation, about the quality of their own performance, 当人们对某一特定情境中可能发生的事情、对自己表现的质量做出错误假设时，焦虑思维便开始并持续存在，
and about what other people are thinking of them. This section includes descriptions of some of the most common styles of thinking that often seem to play a role in social and performance anxiety. Note that there are additional examples of negative and exaggerated thinking that other authors have highlighted (see, for example, Burns 1999) that we have chosen not to include in this section. In most cases, these were omitted either because they were not especially relevant to social anxiety or because they were very similar and overlapped considerably with those examples that we have included. In fact, even the various thinking styles on this list overlap to some extent. As you may notice, a particular anxious thought (something like, “Other people will think that I am boring”) may easily fit into more than one category (probability overestimation, mind reading). 以及关于别人对他们的看法。本节包括了一些最常见的思维方式描述，这些思维方式常常在社交和表现焦虑中起作用。请注意，其他作者也强调了更多负面和夸大的思维例子（例如，参见 Burns 1999），但我们选择未将其包含在本节中。在大多数情况下，这些例子被省略是因为它们与社交焦虑不特别相关，或者与我们所包含的例子非常相似且有较大重叠。事实上，即使是本列表中的各种思维方式在某种程度上也存在重叠。正如你可能注意到的，某个特定的焦虑想法（比如“别人会认为我很无聊”）很容易归入多个类别（概率高估、读心术）。
Probability Overestimations 概率高估
A probability overestimation is a prediction that a person believes is likely to come true, even though the actual likelihood is relatively low. For example, someone who is fearful of giving presentations might predict that the next presentation is likely to go poorly, even though her presentations usually go well. Similarly, a person who is nervous about dating might assume that other people will find him unattractive, even though many people have found him to be attractive in the past. If your thoughts are similar to those listed below, you may have a tendency to overestimate the likelihood of negative events. 概率高估是指一个人相信某个预测很可能会成真，尽管实际发生的可能性相对较低。例如，一个害怕做演讲的人可能会预测下一次演讲很可能会失败，尽管她的演讲通常都很顺利。类似地，一个对约会感到紧张的人可能会认为别人会觉得他没有吸引力，尽管过去有很多人认为他很有吸引力。如果你的想法类似于下面列出的内容，你可能有高估负面事件发生可能性的倾向。
Examples of Probability Overestimations 概率高估的例子
I will be overwhelmed with panic. 我会被恐慌淹没。
Everyone at the party will think I’m stupid. 聚会上的每个人都会认为我很愚蠢。
My presentation will be a disaster. 我的演讲将是一场灾难。
I will never be in an intimate relationship again. 我再也不会有亲密的关系了。
I will have nothing to say if I phone my cousin. 如果我给表弟打电话，我将无话可说。
I will lose my job if I make a mistake. 如果我犯错，我会失去工作。
If I go out, everyone will stare at me. 如果我出去，所有人都会盯着我看。
Can you think of recent instances when you assumed that things were going to work out badly, without any evidence for that assumption? If so, list your own examples of probability overestimations below: 你能想出最近有没有在没有任何证据的情况下，假设事情会朝着不好的方向发展？如果有，请在下面列出你自己对概率高估的例子：
Mind Reading 读心术
Mind reading is actually just an example of a probability overestimation. It involves making negative assumptions about what other people are thinking, particularly what they might be thinking about you. If social anxiety is a problem for you, it is likely that you assume that others think negatively about you. Although it is true that people sometimes make negative judgments about others, the chances are that this occurs much less often than you think. In many cases, your assumptions about what others are thinking are probably exaggerated or even completely untrue. Each of the following kinds of thoughts represents mind reading: 读心术实际上只是概率高估的一个例子。它涉及对别人正在想什么做出负面假设，特别是他们可能对你有什么想法。如果社交焦虑是你的问题，你很可能会假设别人对你有负面看法。虽然人们有时确实会对他人做出负面判断，但这种情况发生的概率很可能远低于你的想象。在许多情况下，你对别人想法的假设可能被夸大了，甚至完全不真实。以下每一种想法都代表了读心术：
Examples of Mind Reading 读心术的例子
People find me boring. 别人觉得我很无聊。
My boss will think I’m an idiot if he sees my hands shaking. 如果老板看到我手在发抖，他会认为我是个白痴。
When people look at me, they are thinking I am strange or weird. 当别人看着我时，他们会觉得我很奇怪或怪异。
Most people see anxiety as a sign of weakness. 大多数人认为焦虑是软弱的表现。
My friends think I am awkward or stupid when I lose my train of thought. 当我思路中断时，我的朋友们认为我很笨拙或愚蠢。
People always know when I am feeling anxious. 人们总能察觉到我感到焦虑。
Can you think of recent examples of times when you have made assumptions about what other people are thinking about you? If so, list your own examples of mind reading below: 你能想出最近有哪些时候你对别人对你的看法做出了假设吗？如果可以，请在下面列出你自己“读心术”的例子：
Personalization 个性化
Personalization is the tendency to take more responsibility for a negative situation than you should, rather than acknowledging all of the different factors that may have contributed to the situation. Here are some examples of personalization, followed by examples of other factors that in reality may have contributed to the situation. 个性化是指在负面情境中，倾向于承担比自己应承担更多的责任，而不是承认可能导致该情境的各种不同因素。以下是一些个性化的例子，随后是一些实际上可能促成该情境的其他因素的例子。
Examples of Personalization 个性化的例子
At a friend’s birthday party, I was talking to another guest and we ran out of things to talk about very quickly. I think the conversation ended so fast because I am so boring and can’t think of things to say. 在朋友的生日派对上，我和另一位客人在聊天，但我们很快就没话题了。我认为对话结束得这么快是因为我太无聊了，想不出要说的内容。
The fact that my boss got angry at me for making a mistake is proof that I am incompetent. 我老板因为我犯了一个错误而生气，这证明了我无能。
People were falling asleep during my presentation, proving once again that I am a really boring speaker. 人们在我的演讲中打瞌睡，这再次证明我是一个非常无聊的演讲者。
I was in an elevator and a woman was looking at me. She was probably thinking that I looked strange. 我在电梯里，一位女士在看着我。她可能在想我看起来很奇怪。
In Reality 现实中
In reality, other factors that may have contributed to the situation include (1) the other person couldn’t think of anything to talk about, (2) I had nothing in common with the other guest, even though neither of us is actually boring, and (3) it is normal for many conversations at parties to end fairly quickly. Nobody was at fault. 实际上，可能导致这种情况的其他因素包括：(1) 对方想不出什么话题可聊，(2) 我和另一位客人没有共同点，尽管我们两人其实都不无聊，(3) 在聚会上许多对话很快就结束是正常的。没有人有错。
In reality, other factors that may have contributed to the situation include (1) my boss is always getting angry at people, so I shouldn’t feel singled out, (2) my boss’s expectations are too high (I know that not every boss in the world would have yelled at me for making a mistake; part of why my boss became angry had to do with his own expectations, rather than me making a mistake), and (3) there are many reasons why people make mistakes besides incompetence. 实际上，可能导致这种情况的其他因素包括：(1) 我的老板总是对人发火，所以我不应该觉得自己被针对，(2) 我老板的期望太高了（我知道并不是所有老板都会因为我犯错而对我大喊大叫；我老板生气的部分原因是他的期望，而不是我犯了错），(3) 人们犯错的原因有很多，除了无能之外。
In reality, other factors that may have contributed to the situation include (1) the topic was somewhat dry and would have been difficult for any speaker to make exciting, (2) the presentation was late in the day, and the audience was feeling tired, and (3) it is normal for some people to feel bored at a talk; other people probably found it interesting. 实际上，可能导致这种情况的其他因素包括：(1) 话题有些枯燥，任何演讲者都难以使其变得精彩，(2) 演讲安排在一天的晚些时候，听众感到疲倦，(3) 有些人觉得演讲无聊是正常的；其他人可能觉得很有趣。
In reality, other factors that may have contributed to the situation include (1) she was staring at me because she liked the way I look or what I was wearing, (2) she was looking in my direction but wasn’t really looking at me (maybe she was staring into space or daydreaming), and (3) she noticed me but was thinking of other things. 实际上，可能导致这种情况的其他因素包括（1）她盯着我看是因为她喜欢我的外貌或我穿的衣服，（2）她朝我的方向看但并没有真正看着我（也许她在发呆或做白日梦），以及（3）她注意到了我但在想着别的事情。
Can you think of recent examples of times when you engaged in personalization? If so, list your own examples of personalization in the space below: 你能想出最近有哪些时候你进行了个性化解读吗？如果能，请在下面的空白处列出你自己的个性化解读例子：
"Should" Statements “应该”陈述
“Should” statements are incorrect or exaggerated assumptions about the way things ought to be. Statements that include words like “always,” “never,” “should,” and “must” are often “should” statements. Sometimes, the tendency to use words such as these is a sign of having overly rigid and perfectionistic expectations for yourself or for others. Here are some examples: “应该”陈述是关于事情应当如何的错误或夸大的假设。包含“总是”、“从不”、“应该”和“必须”等词语的陈述通常是“应该”陈述。有时，倾向于使用这些词语是对自己或他人抱有过于僵化和完美主义期望的表现。以下是一些例子：
Examples of "Should" Statements “应该”陈述的例子
I should never feel nervous around other people. 我在别人面前绝不应该感到紧张。
I must never let my anxiety show. 我绝不能让别人看到我的焦虑。
I should never make mistakes. 我绝不应该犯错误。
I must never inconvenience other people. 我绝不能给别人带来不便。
Others should never think badly about me. 别人绝不应该对我有不好的看法。
I ought never to do anything to draw attention to myself. 我不应该做任何引起别人注意的事情。
Others must never tease me or laugh at something that I have done. 别人绝不能取笑我或嘲笑我所做的事情。
I should always be interesting and entertaining to others. 我应该总是对别人有趣且富有娱乐性。
I must do things perfectly so everything is just right. 我必须完美地完成事情，这样一切才会恰到好处。
In the space below, list examples from your own life of unreasonable expectations (“shoulds”) that you hold for yourself or others: 在下面的空白处，列举你自己生活中对自己或他人持有的不合理期望（“应该”）的例子：
Catastrophic Thinking 灾难性思维
Catastrophic thinking (also known as catastrophizing) is the tendency to assume that if a negative event were to occur, it would be absolutely terrible and unmanageable. From time to time, we all make mistakes, offend others, or look foolish. One difference between people who are socially anxious and those who are not particularly anxious is how they deal with these unfortunate social events. People who have very little social anxiety are often able to say to themselves, “Who cares what this person thinks? I have the right to make a mistake from time to time.” Or, “I feel sorry that I upset that person, 灾难性思维（也称为灾难化）是指倾向于假设如果发生了负面事件，那将是绝对可怕且无法应对的。我们偶尔都会犯错、冒犯他人或显得愚蠢。社交焦虑者与不太焦虑者之间的一个区别在于他们如何处理这些不幸的社交事件。社交焦虑很少的人通常能够对自己说：“谁在乎这个人怎么想？我有权偶尔犯错。”或者，“我很遗憾让那个人不高兴了，
but everyone puts their foot in it at times.” In contrast, people who feel anxious around others are more likely to think, “It would be a disaster to have others think badly of me.” Below are more examples of catastrophic thinking: 但每个人有时都会犯错。”相比之下，感到他人面前焦虑的人更可能想，“如果别人对我有不好的看法，那将是一场灾难。”以下是更多灾难性思维的例子：
Examples of Catastrophic Thinking 灾难性思维的例子
It would be terrible if my anxiety showed during my presentation. 如果我在演讲中表现出焦虑，那将是可怕的。
I would not be able to handle making a fool of myself. 我无法承受出丑的局面。
It would be terrible to be unable to think of things to say during my date on Saturday night. 在周六晚的约会中想不出话说，那将是件可怕的事。
If someone shows signs of not liking me, it feels like the end of the world. 如果有人表现出不喜欢我，感觉就像世界末日一样。
It would be terrible to lose my train of thought during a presentation. 在演讲中丢失思路，那将是件可怕的事。
It would be a disaster if I blushed while answering a question in class. 如果我在课堂上回答问题时脸红，那将是一场灾难。
In the space below, list examples of times when you have catastrophized or exaggerated how bad a particular outcome would be if it actually were to occur: 在下面的空白处，列举一些你曾经将某个结果会有多糟糕进行灾难化或夸大的例子：
All-or-Nothing Thinking 非黑即白的思维
All-or-nothing thinking (also called black-and-white thinking) is the tendency to judge any performance that falls short of perfection as being completely unacceptable. People who engage in this style of thinking tend to categorize their behavior as being either perfect or awful, without acknowledging all of the possibilities that lie between these two extremes. As with “should” statements, all-or-nothing thinking is associated with excessive perfectionism and a tendency to hold unrealistic standards. Following are several examples of all-or-nothing thinking: 非黑即白的思维（也称为黑白思维）是指倾向于将任何未达到完美的表现判断为完全不可接受的倾向。采用这种思维方式的人往往将自己的行为归类为要么完美，要么糟糕，而不承认这两个极端之间存在的所有可能性。与“应该”陈述类似，非黑即白的思维与过度完美主义和持有不切实际标准的倾向有关。以下是非黑即白思维的几个例子：
Examples of All-or-Nothing Thinking 非黑即白思维的例子
If I lose my train of thought even once, I will blow the entire presentation. 如果我一旦走神，我就会把整个演讲搞砸。
Even one person thinking I look nervous is too many. 即使只有一个人觉得我看起来紧张，那也太多了。
If I don’t get an A on my exam, my teacher will think I am stupid. 如果我考试没考到 A，老师就会认为我很笨。
It is unacceptable if my boss makes any negative comments or suggests even one area for improvement during my annual performance review. 如果我的老板在年度绩效评估中提出任何负面评论或建议哪怕一个改进的方面，那是不可接受的。
Showing any signs of anxiety is almost as bad as falling completely apart. 表现出任何焦虑的迹象几乎和完全崩溃一样糟糕。
In the space below, list examples of the times when you engaged in all-or-nothing thinking: 在下面的空白处，列举你进行非黑即白思维的例子：
Selective Attention and Memory 选择性注意和记忆
Selective attention is the tendency to pay more attention to certain types of information than to other types. Selective memory is the tendency to remember certain types of information more easily than other types. As discussed earlier, people are more likely to attend to and remember information that is consistent with their beliefs. Therefore, people with social anxiety are more likely than others to remember times when they were criticized or teased by another person or when they performed poorly in a social situation. When performing in social situations or interacting with others, individuals with social phobia are more likely to notice people who appear to be bored or disapproving. Some other examples of selective memory and attention are provided below: 选择性注意是指倾向于比其他类型的信息更关注某些特定类型的信息。选择性记忆是指倾向于比其他类型的信息更容易记住某些特定类型的信息。如前所述，人们更有可能关注和记住与其信念一致的信息。因此，社交焦虑者比其他人更容易记住被他人批评或嘲笑的时刻，或在社交场合表现不佳的经历。在社交场合表演或与他人互动时，社交恐惧症患者更容易注意到那些看起来无聊或不赞同的人。以下是一些选择性记忆和注意的其他例子：
Examples of Selective Attention and Memory 选择性注意和记忆的例子
Ignoring positive feedback from a teacher or boss (in other words, discounting positive feedback as if it doesn’t matter), yet taking negative feedback very seriously (for example, letting negative feedback ruin your day) 忽视老师或老板的积极反馈（换句话说，忽视积极反馈，好像它无关紧要），但却非常认真对待负面反馈（例如，让负面反馈毁掉你的一天）
Focusing on the one low grade on your report card and ignoring all the high grades 关注成绩单上的一个低分，而忽略所有的高分
Remembering being teased in high school, while forgetting about the good times spent with friends after school 记得高中时被取笑的事情，却忘记了放学后与朋友们共度的美好时光
Focusing on audience members who seem bored during your presentation and ignoring those in the crowd who appear to be enjoying your talk 在演讲时关注那些看起来无聊的听众，忽视那些似乎在享受你演讲的人群
Focusing on the moment during a conversation when you stumbled over your words and lost your train of thought, while ignoring the fact that the rest of the conversation was fairly smooth 在对话中专注于你结巴、思路中断的那一刻，而忽略了对话其余部分相当顺利的事实
Can you think of ways in which you selectively pay attention to events or information that confirm your anxious beliefs and selectively ignore information that is inconsistent with those beliefs? In the space below, list examples of times when you have engaged in selective attention or memory: 你能想到哪些方式是你有选择地关注那些证实你焦虑信念的事件或信息，而有选择地忽视与这些信念不符的信息吗？请在下面的空白处列举你曾进行选择性注意或记忆的例子：
Negative Core Beliefs 消极核心信念
In addition to paying attention to your negative thinking in particular situations that trigger your anxiety, it may also be useful to become more aware of any deeper, more central, and long-standing assumptions that contribute to your feelings of anxiety. These assumptions are called core beliefs and they can include negative assumptions that people hold about themselves (for example, “I am incompetent”), other people (for instance, “Other people cannot be trusted”), and the world (such as, “The world is a dangerous place”). The more strongly held these core beliefs are, the more difficult they may be to change. 除了关注在引发你焦虑的特定情境中的消极思维外，了解那些更深层次、更核心且长期存在的假设也可能对你有所帮助，这些假设助长了你的焦虑感。这些假设被称为核心信念，它们可能包括人们对自己（例如，“我无能”）、对他人（例如，“别人不可信”）以及对世界（例如，“世界是危险的地方”）所持有的消极假设。核心信念持有得越强烈，改变起来可能就越困难。
One technique for uncovering core beliefs involves continually asking about the meaning of each fearful belief you have until the core beliefs underlying your anxious interpretations are revealed. This process is illustrated in the following conversation between Liam and his therapist: 揭示核心信念的一种方法是不断追问你每一个恐惧信念的含义，直到揭示出你焦虑解读背后的核心信念。以下是利亚姆与他的治疗师之间的对话，展示了这一过程：
Liam: I am terrified to ask my coworker Cindy out on a date. 利亚姆：我害怕约我的同事辛迪出去约会。
Therapist: What are you afraid might happen if you ask her out? 治疗师：如果你约她出去，你害怕会发生什么？
Liam: Mostly, I’m afraid she will say no. 利亚姆：主要是我害怕她会拒绝我。
Therapist: Why would that be a problem? 治疗师：那为什么会是个问题呢？
Liam: If she rejects me, it will probably mean that she doesn’t find me attractive. 利亚姆：如果她拒绝我，可能意味着她不觉得我有吸引力。
Therapist: What would be so bad about that? 治疗师：那有什么那么糟糕的呢？
Liam: It will confirm my own belief that I am unattractive. 利亚姆：那会证实我自己认为我不吸引人的看法。
Therapist : What if that’s true? 治疗师：如果那是真的呢？
Liam: Well, if I really am unattractive, that means nobody will ever think I’m attractive or want to date me. It would mean that I am unlovable. 利亚姆：嗯，如果我真的不吸引人，那就意味着没人会觉得我有吸引力或想和我约会。这意味着我不可被爱。
Therapist: What would be bad about being unlovable? 治疗师：被认为不可爱有什么坏处？
Liam: If I am unlovable, I am bound to be alone forever. 利亚姆：如果我不可爱，我注定会永远孤独。
Therapist: So, to summarize, you seem to be saying that (1) if another person turns down your invitation for a date, it means that she finds you unattractive, (2) if another person finds you unattractive, then everyone will find you unattractive, (3) being turned down for a date means that you are unlovable and destined to be alone forever. Do you think of yourself as unlovable? 治疗师：总结一下，你似乎在说：（1）如果别人拒绝了你的约会邀请，意味着她觉得你没有吸引力；（2）如果别人觉得你没有吸引力，那么每个人都会觉得你没有吸引力；（3）被拒绝约会意味着你不可爱，注定要孤独终老。你认为自己不可爱吗？
Liam: I think I do. Part of me knows it isn’t true, but much of the time I just can’t shake that belief. 利亚姆：我想是的。我内心有一部分知道这不是真的，但大多数时候我就是无法摆脱这种信念。
HOW TO IDENTIFY YOUR ANXIOUS THOUGHTS AND PREDICTIONS 如何识别你的焦虑思维和预测
In chapter 3, we discussed strategies for identifying your anxious thoughts. We suggest that you review the relevant passages in chapter 3 on identifying anxious thoughts before trying to use the techniques discussed in the remainder of this chapter. There is no point trying to change your anxious beliefs unless you are clear about the content of these beliefs. In addition to reviewing the anxious thoughts recorded in chapter 3, identifying your anxious beliefs, predictions, and assumptions should be an ongoing process. Whenever you find yourself in an anxiety-provoking situation, try to identify the specific thoughts and beliefs that contribute to your discomfort. In most cases, you can identify your anxious predictions and assumptions by asking yourself a series of questions such as the following: 在第三章中，我们讨论了识别焦虑思维的策略。我们建议你在尝试使用本章其余部分讨论的技巧之前，先回顾第三章中关于识别焦虑思维的相关内容。除非你清楚这些信念的具体内容，否则试图改变你的焦虑信念是没有意义的。除了回顾第三章中记录的焦虑思维外，识别你的焦虑信念、预测和假设应当是一个持续的过程。每当你发现自己处于引发焦虑的情境中时，尝试识别那些导致你不适的具体思维和信念。在大多数情况下，你可以通过问自己一系列问题来识别你的焦虑预测和假设，例如：
What am I afraid will happen in this situation? 在这种情况下，我害怕会发生什么？
What do I fear that the other person will think about me? 我害怕对方会如何看待我？
What will happen if my anxious thoughts are true? 如果我的焦虑想法成真了，会发生什么？
Sometimes it may be difficult to pinpoint your fearful thoughts. Chances are that social anxiety has been a part of your life for so long that your negative thoughts are well-rehearsed, very quick, and almost automatic (like habits). Also, the fact that you probably avoid the situations you fear makes it that much more difficult to remember exactly what thoughts tend to occur when you are actually in the situation. 有时可能很难准确找出你害怕的想法。很可能社交焦虑已经成为你生活的一部分很长时间了，以至于你的消极想法已经非常熟练、非常迅速，几乎是自动的（像习惯一样）。此外，你可能会避免你害怕的情境，这也使得你更难记住在实际处于该情境时通常会出现哪些想法。
If you have difficulty identifying your anxious beliefs, we suggest that you try to engage with the situations you fear and attempt to identify your assumptions and predictions while you are still in the situation. With practice, it should get easier to recognize your anxious beliefs. In fact, even if you are unable to identify the specific thoughts that contribute to your anxiety, practicing being in the situation will likely lead to a decrease in your fear, as discussed in chapters 7 and 8 . 如果你难以识别你的焦虑信念，我们建议你尝试接触你害怕的情境，并在仍处于该情境时尝试识别你的假设和预测。通过练习，识别你的焦虑信念应该会变得更容易。事实上，即使你无法识别导致焦虑的具体想法，练习处于该情境中也可能会减少你的恐惧，正如第 7 章和第 8 章中所讨论的那样。
STRATEGIES FOR CHANGING ANXIOUS THINKING 改变焦虑思维的策略
This section provides an overview of seven different techniques for changing the beliefs and predictions that contribute to your social anxiety. These include (1) examining the evidence for your beliefs, (2) challenging catastrophic thinking, (3) remembering your strengths, (4) seeing yourself as others do, (5) examining the costs and benefits of your thoughts, (6) creating rational coping statements, and (7) conducting behavioral experiments. Along with a description of each strategy, we include exercises to provide opportunities to try each technique. Near the end of the chapter, we offer some suggestions for tying together all the pieces and for integrating the cognitive therapy techniques into your larger treatment plan. 本节概述了七种改变导致你社交焦虑的信念和预测的不同技巧。这些技巧包括：（1）审视你信念的证据，（2）挑战灾难性思维，（3）记住你的优点，（4）以他人的视角看待自己，（5）审视你想法的利弊，（6）创建理性的应对语句，以及（7）进行行为实验。除了对每种策略的描述外，我们还提供了练习，帮助你有机会尝试每种技巧。在本章接近尾声时，我们会提出一些建议，帮助你将所有部分整合起来，并将认知疗法技巧融入你的整体治疗计划中。
Examining the Evidence 审视证据
The fact that you are anxious about being judged by others in a particular situation doesn’t mean that your fearful predictions and thoughts are true. In fact, what we assume others are thinking is often completely different than what other people actually think of us. How many times have you heard someone say, “My hair looks awful” or “I am such a loser” and thought to yourself that the individual was just fine? If you are consistently assuming you’re inferior in the eyes of others, you are probably exaggerating or misinterpreting other people’s reactions to your appearance, behavior, or performance. 你在特定情境中担心被他人评判，并不意味着你那些恐惧的预测和想法是真实的。事实上，我们以为别人正在想的，往往与他们实际对我们的看法完全不同。你有多少次听到有人说“我的头发看起来很糟”或“我真是个失败者”，却心里觉得那个人其实没问题？如果你总是认为自己在别人眼中很差劲，那么你很可能是在夸大或误解别人对你外貌、行为或表现的反应。
The first step toward changing your thoughts is to recognize that your beliefs are not facts. Rather than assuming that your beliefs are true, it is important to treat your anxious thoughts as guesses or hypotheses. By examining the evidence, you will be able to assess the extent to which your beliefs are true. Remember, your natural tendency may be to seek out only information that confirms your negative beliefs about yourself. Examining the evidence involves trying to achieve a more balanced view by looking at all the evidence, especially information that contradicts or disproves your anxious thoughts and predictions. 改变你思维的第一步是认识到你的信念并非事实。与其假设你的信念是真实的，不如将你的焦虑想法视为猜测或假设。通过审视证据，你将能够评估你的信念在多大程度上是真实的。请记住，你的自然倾向可能是只寻找那些证实你对自己负面信念的信息。审视证据意味着尝试通过查看所有证据，尤其是那些与焦虑想法和预测相矛盾或驳斥的信息，来实现更平衡的观点。
In order to examine the evidence for your beliefs, we recommend you get into the habit of asking yourself questions such as the following: 为了审视你信念的证据，我们建议你养成问自己以下问题的习惯：
How do I know for sure that my prediction will come true? 我怎么能确定我的预测一定会成真？
What does my past experience tell me about the likelihood of my thoughts coming true? 我的过去经历告诉我这些想法成真的可能性有多大？
Have there been times when I have experienced anxious thoughts that didn’t come true? 有没有经历过一些焦虑的想法，但最终并没有成真？
Are there facts or statistics that can help me to decide whether my prediction is likely to come true? 有没有事实或统计数据可以帮助我判断我的预测是否可能成真？
Are there other possible interpretations for this situation? 对于这种情况，还有其他可能的解释吗？
How might another person interpret this situation? 别人可能会如何解读这种情况？
You may find it useful to type these questions on a small index card and carry that card as a reminder in your pocket or wallet. Essentially, examining the evidence involves four basic steps: identifying your anxious beliefs, generating alternative beliefs, weighing the evidence supporting and contradicting your beliefs, and choosing more realistic beliefs. Asking questions similar to those listed above will help you to identify alternative beliefs and to evaluate the evidence concerning your anxious and alternative beliefs. An illustration of how to use this strategy to combat a fear of shaking during a presentation appears below: 你可能会发现，将这些问题打印在一张小索引卡上，并将这张卡片放在口袋或钱包里作为提醒，会很有用。基本上，审视证据包括四个基本步骤：识别你的焦虑信念，产生替代信念，权衡支持和反驳你信念的证据，以及选择更现实的信念。提出类似上述问题将帮助你识别替代信念，并评估与你的焦虑信念和替代信念相关的证据。下面是一个如何使用这一策略来对抗在演讲时害怕手抖的示例：
Steps for Examining the Evidence 审视证据的步骤
Identify the Anxious Thought 识别焦虑想法
The audience will think I am incompetent if they see my hands shaking during my talk. 如果观众看到我演讲时手在抖，他们会认为我无能。
Generate Alternative Beliefs 生成替代信念
Nobody will notice my shaking. 没有人会注意到我在发抖。
Only a small number of people will notice my shaking. 只有少数人会注意到我在发抖。
People who notice my shaking will think I am tired or that I have had too much coffee. 注意到我发抖的人会认为我很累或者喝了太多咖啡。
People who notice my shaking will think I am feeling a bit anxious. 注意到我发抖的人会认为我有点紧张。
It is normal to shake sometimes, so people will think nothing of it if they notice my shaky hands. 有时发抖是正常的，所以如果有人注意到我手抖，他们不会多想。
Examine the Evidence 审视证据
Evidence Supporting Your Anxious Belief 支持你焦虑信念的证据
I believe that my shaking is very extreme. 我相信我的颤抖非常严重。
A few people have commented on my shaky hands over the years. 多年来，有几个人评论过我的手抖。
I tend to notice when other people shake. 我倾向于注意到别人颤抖的时候。
Evidence Supporting Your Alternative Beliefs 支持你替代信念的证据
I know others with shaky hands, and people don’t seem to think they are incompetent. 我认识一些手抖的人，别人似乎并不认为他们无能。
When I notice other people shaking, I don’t think they are incompetent. 当我注意到别人手抖时，我并不认为他们无能。
Often people seem not to have noticed me shaking when I asked them if it was noticeable. 当我问别人我的手抖是否明显时，通常他们似乎没有注意到。
When people have noticed my shaking, they haven’t tended to treat me differently. 当别人注意到我手抖时，他们通常不会因此对我有不同的看法。
The people in the audience know me well. I can’t imagine that their opinions of me would change dramatically based on whether my hands shook during a single presentation. 观众中的人们很了解我。我无法想象他们对我的看法会因为我在一次演讲中手抖而发生巨大变化。
Choose a More Realistic Belief 选择一个更现实的信念
Some people may notice my shaky hands, but it’s unlikely that they will think I’m incompetent. 有些人可能会注意到我手抖，但他们不太可能认为我无能。
The following form can be used as you begin to work on examining the evidence supporting and contradicting your anxious beliefs. You may want to make copies of this form so that you can continue to use it whenever you encounter a feared situation. 当你开始着手审视支持和反驳你焦虑信念的证据时，可以使用以下表格。你可能想要复印这张表格，以便在遇到恐惧情境时继续使用。
Form for Examining the Evidence 证据审查表
Situation 情境
qquad\qquad qquad\qquad qquad\qquad
Anxious Beliefs, Predictions, and Interpretations 焦虑的信念、预测和解释 qquad\qquad qquad\qquad qquad\qquad
Alternative (Non-Anxious) Beliefs, Predictions, and Interpretations 替代的（非焦虑的）信念、预测和解释 qquad\qquad qquad\qquad qquad\qquad
Evidence Supporting My Anxious Beliefs, Predictions, and Interpretations 支持我焦虑信念、预测和解释的证据 qquad\qquad qquad\qquad qquad\qquad
Evidence Contradicting My Anxious Beliefs, Predictions, and Interpretations 反驳我焦虑信念、预测和解释的证据 qquad\qquad qquad\qquad qquad\qquad
Choosing a More Realistic Way of Thinking 选择一种更现实的思维方式
qquad\qquad qquad\qquad qquad\qquad
To further illustrate the process of examining the evidence, here is an example of a discussion between Stephen and his therapist demonstrating how to first identify anxious beliefs and then challenge those beliefs based on your past experiences. 为了进一步说明审视证据的过程，以下是 Stephen 与他的治疗师之间的一段对话示例，展示了如何首先识别焦虑信念，然后根据你的过去经历挑战这些信念。
Therapist: What are you afraid will happen if you attend your company picnic next week? 治疗师：如果你参加下周的公司野餐，你害怕会发生什么？
Stephen: I am nervous that I won’t be able to come up with anything to say to anyone. Everyone else will be talking about their children. I’m not in a relationship, and I have no kids, so I will have nothing in common with any of them. 斯蒂芬：我很紧张，担心自己找不到话题和别人交流。其他人都会谈论他们的孩子。而我没有恋爱关系，也没有孩子，所以我和他们没有共同话题。
Therapist: How sure are you that you will have nothing to say? 治疗师：你有多确定自己会没有话题可说？
Stephen: Probably about 90 percent. 斯蒂芬：大概有 90%的把握。
Therapist: What that means is that nine out of ten times that you attend an event such as this one, you have nothing to say. Is this really true? What happened at last year’s company picnic? 治疗师：这意味着你参加类似这样的活动时，有九成的时间你都无话可说。这是真的吗？去年公司的野餐会上发生了什么？
Stephen: When I first arrived, it was difficult. I stood off to the side and didn’t say much to others. After a while, people started to include me in their conversations and it got easier. I think it was especially difficult last year because I had just started at the company and didn’t know anyone very well. 斯蒂芬：刚到的时候确实很难。我站在一旁，没怎么和别人说话。过了一会儿，人们开始把我拉进他们的谈话中，情况就变得容易些了。我觉得去年特别难是因为我刚进公司，还不太认识谁。
Therapist: Were you able to think of things to say? 治疗师：你能想到要说的话题吗？
Stephen: At first, I struggled. I think it was harder for me than it was for the others, but I was able to think of a few things to talk about, especially later in the afternoon. 斯蒂芬：一开始我很挣扎。我觉得我比别人更难，但我还是能想到一些话题，尤其是下午晚些时候。
Therapist: Did everyone at last year’s picnic bring a partner or spouse? Did they all talk about their children? 治疗师：去年的野餐会上每个人都带了伴侣或配偶吗？他们都谈论他们的孩子吗？
Stephen: No. In fact, there are a few other single people at work. Last year, lots of people ended up talking about work. 斯蒂芬：没有。事实上，工作中还有其他几个单身的人。去年，很多人最后都谈论了工作。
Therapist: Thinking back to last year’s company picnic, do you still think that you won’t have anything to say at this year’s picnic? 治疗师：回想去年的公司野餐，你还认为今年的野餐会上你会无话可说吗？
Stephen: Well, I may not be as talkative as some other people, but I suppose I will probably find something to talk about. Maybe it will be easier this year because I’ve worked with these people for over a year, so I know them much better. 斯蒂芬：嗯，我可能不会像其他人那样健谈，但我想我大概会找到话题。也许今年会更容易些，因为我和这些人已经共事一年多了，所以我对他们了解得更多。
Challenging Catastrophic Thinking 挑战灾难性思维
Challenging catastrophic thinking requires shifting the focus of your thoughts from how terrible a particular outcome would be to how you might manage or cope with the situation if it were to occur. One of the most effective ways of overcoming your catastrophic thoughts is to ask yourself questions like the following: 挑战灾难性思维需要将你的注意力从某个结果会有多糟糕，转移到如果这种情况真的发生，你将如何应对或处理。克服灾难性思维的最有效方法之一是问自己以下这样的问题：
So what? 那又怎样？
What if my fears actually come true? 如果我的恐惧真的成真了怎么办？
How can I cope with qquad\qquad if it were to occur? 如果 qquad\qquad 真的发生了，我该如何应对？
Would qquad\qquad really be as terrible as I think? qquad\qquad 真的会像我想象的那样糟糕吗？
Does this really matter in the big scheme of things? 从大局来看，这真的重要吗？
Will I care about this a month from now? A year from now? 一个月后我还会在意这件事吗？一年后呢？
In many cases, you will realize that even if your fear does come true, it won’t be the end of the world. You will cope with the situation, and your discomfort will pass. Below you will see a discussion between Aimee and her therapist illustrating how to use this technique to challenge catastrophic thoughts related to asking someone out on a date. 在许多情况下，你会意识到，即使你的恐惧真的成真了，也不会是世界末日。你会应对这种情况，你的不适感也会过去。下面你将看到 Aimee 和她的治疗师之间的对话，展示如何使用这种技巧来挑战与约人出去相关的灾难性想法。
Aimee: I am terrified of asking anyone out on a date for fear of rejection. Aimee：我害怕约任何人出去，害怕被拒绝。
Therapist: Is there a particular person whom you have considered asking out? 治疗师：有没有特别的人是你考虑过要约出去的？
Aimee: There is a guy in one of my classes. I’ve sat with him a few times. The class ends just before lunch, so I’ve thought of asking him to have lunch with me. Aimee：我班上有个男生。我和他坐过几次。课在午饭前结束，所以我想过约他一起吃午饭。
Therapist: What’s stopping you? What do you think might happen if you ask him to join you for lunch? 治疗师：是什么阻止了你？如果你邀请他一起吃午饭，你觉得会发生什么？
Aimee: Mostly, I am afraid he won’t be interested in me. I will put him on the spot and he’ll have to come up with an excuse for rejecting my offer. I’m afraid he’ll think I’m stupid, or even worse, he’ll feel sorry for me. 艾米：主要是我害怕他对我不感兴趣。我会让他处于尴尬的境地，他不得不找借口拒绝我的邀请。我害怕他会觉得我很傻，或者更糟的是，他会对我感到可怜。
Therapist: As we’ve discussed previously, there are many different possible reactions that he could have. Thinking you’re stupid or feeling sorry for you are just two of many possibilities. Nevertheless, let’s assume for a moment that your fears actually are true. What if he does think you are foolish and pathetic? 治疗师：正如我们之前讨论过的，他可能有很多不同的反应。觉得你傻或者对你感到可怜只是众多可能性中的两种。不过，暂且假设你的担忧是真的。如果他真的觉得你愚蠢和可怜呢？
Aimee: I don’t know. I hadn’t really thought beyond that. I would feel terrible. 艾米：我不知道。我之前没想过后续会怎样。我会感觉很糟糕。
Therapist: Would it mean that you really are pathetic and stupid? 治疗师：这是否意味着你真的很可怜和愚蠢？
Aimee: I suppose not. 艾米：我想不是。
Therapist: Would it mean that all other people also think you are stupid and pathetic? 治疗师：这是否意味着所有其他人也认为你愚蠢和可怜？
Aimee: quad\quad Not really. 艾米： quad\quad 不完全是。
Therapist: Why not? 治疗师：为什么不呢？
Aimee: Well, his opinion doesn’t reflect that of other people. I know my friends don’t think I’m pathetic. At least I hope not. 艾米：嗯，他的看法并不代表其他人的想法。我知道我的朋友们并不认为我可怜。至少我希望不是这样。
Therapist: If you’re not stupid or pathetic, why else would he reject you? 治疗师：如果你不是愚蠢或可怜，他为什么还会拒绝你呢？
Aimee: Perhaps he might have other lunch plans. Or, maybe he already has a girlfriend. 艾米：也许他有其他的午餐计划。或者，他可能已经有女朋友了。
Therapist: Those are both possibilities, but let’s come back to your original thoughts. What if he really thinks you’re pathetic and that’s why he isn’t interested in spending time with you? 治疗师：这两种可能都有，但我们回到你最初的想法。如果他真的觉得你很可怜，这就是他不愿意和你共度时光的原因呢？
Aimee: I guess it wouldn’t matter. Over the past few weeks, I’ve come to recognize that not everyone has to like me. Perhaps it would mean that we’re just not a good match. 艾米：我想那也无所谓。过去几周，我开始意识到并不是每个人都必须喜欢我。也许这意味着我们只是彼此不合适。
Theratist: If he declines your offer for lunch, do you think you will be able to cope with the feelings of rejection? 治疗师：如果他拒绝了你的午餐邀请，你觉得你能应对被拒绝的感觉吗？
Aimee: I think so. It will feel bad at first, but I think I can stop myself from getting too down on myself. 艾米：我想可以。一开始会感觉不好，但我觉得我能阻止自己过于自责。
Overcoming catastrophic thinking also involves combating the tendencies to concentrate only on the immediate consequences of some negative experience (for example, “People will think badly about me during my presentation”) and to forget that your discomfort will pass after a short time. In reality, the consequences of making a mistake or of embarrassing yourself are usually minimal and almost never last very long. Even if people notice that you have made a mistake or that you appear to be anxious, they are likely to forget about it after a few minutes. 克服灾难性思维还包括对抗只关注某些负面经历的直接后果的倾向（例如，“人们会在我演讲时对我有不好的看法”），以及忘记你的不适感会在短时间内过去的事实。实际上，犯错或让自己尴尬的后果通常是微不足道的，几乎不会持续很长时间。即使人们注意到你犯了错误或看起来很焦虑，他们也很可能在几分钟后就忘记了。
We have included a Decatastrophizing Form toward the end of this chapter to help you challenge your catastrophic thoughts in social situations. The form includes three columns. In the first column, you should describe the situation that led you to feel anxious. In the second column, describe your anxious thoughts and predictions. Now, ask the questions provided in the previous bulleted list (such as, “So what?”) and record your noncatastrophic responses in the third column. Following are some examples. 我们在本章末尾附上了一份“去灾难化表格”，帮助你在社交场合中挑战你的灾难性思维。该表格包含三栏。第一栏，你应描述导致你感到焦虑的情境。第二栏，描述你的焦虑想法和预测。现在，提出前面项目符号列表中提供的问题（例如，“那又怎样？”），并在第三栏记录你的非灾难性回应。以下是一些示例。
Column 1 (Examples of Situations) 第一栏（情境示例）
Giving a presentation 做演讲
Having difficulty thinking of things to say during a conversation 在谈话中难以想到要说的话
Attending a party 参加聚会
Asking someone out on a date 约某人出去约会
Walking through a busy mall 走过一个繁忙的购物中心
Column 2 (Examples of Anxious Thoughts) 第 2 栏（焦虑思维示例）
∙\bulletqquad\qquad will think I am stupid. ∙\bulletqquad\qquad 会认为我很愚蠢。
My hands will shake. 我的手会发抖。
I will look weak or incompetent. 我会显得软弱或无能。 ∙\bulletqquad\qquad will feel sorry for me. ∙\bulletqquad\qquad 会为我感到难过。
My anxiety will be noticed by qquad\qquad . 我的焦虑会被 qquad\qquad 注意到。
Column 3 (Examples of Noncatastrophic Responses) 第 3 栏（非灾难性反应示例）
Even if qquad\qquad thinks I’m an idiot, it doesn’t mean I really am one. His opinion doesn’t reflect that of everyone else. 即使 qquad\qquad 认为我是个傻瓜，也不代表我真的是。他的看法并不代表所有人的观点。
It wouldn’t be the end of the world if qquad\qquad noticed my anxiety. Everyone feels anxious from time to time. 如果 qquad\qquad 注意到我的焦虑，也不会是世界末日。每个人都会时不时感到焦虑。
Who cares if my hands shake? I have the right to have shaky hands. Probably no one will even notice. Even if they notice, they probably won’t care. My boss has shaky hands and nobody seems to care. 我的手抖又有什么关系？我有权利手抖。可能没人会注意到。即使注意到了，他们大概也不会在意。我的老板手抖，但似乎没人介意。
If I am ridiculed or laughed at, it would be manageable. Most people get teased and ridiculed from time to time. I certainly laugh at other people sometimes. Other than the temporary discomfort or embarrassment, it wouldn’t really matter in the big scheme of things. 如果我被嘲笑或取笑，也能应付得了。大多数人都会时不时被取笑和嘲弄。我当然有时也会笑别人。除了暂时的不适或尴尬，从大局来看，这并不重要。
Remembering Your Strengths 记住你的优点
If you tend to focus on small mistakes and perceived flaws in your personality or appearance, you will likely continue to feel anxious. For example, if you assume that everyone is judging you based on whether your hands shake, you are more likely to 如果你倾向于关注自己性格或外貌上的小错误和感知到的缺陷，你很可能会继续感到焦虑。例如，如果你认为每个人都在根据你的手是否发抖来评判你，那么当你的手发抖时，你更可能感到紧张。
be nervous when your hands are shaking. Similarly, if you assume that everyone else is criticizing you based on ten seconds during your presentation when you lost your train of thought, you will probably continue to be nervous when giving presentations. Although it is true that we all judge and criticize other people from time to time, it is unlikely that people are noticing and judging the specific behaviors that you assume are being criticized. 同样地，如果你认为别人都在批评你在演讲中十秒钟走神的表现，那么你在做演讲时很可能会继续感到紧张。虽然我们确实会时不时地评判和批评别人，但人们注意并评判你认为被批评的具体行为的可能性并不大。
People’s judgments of one another are based on many different dimensions, including appearance (for example, height, weight, hair color and style, facial features, clothing, shoes, and so on), intelligence (for instance, verbal abilities, problem-solving skills, knowledge of trivia, and so on), competence (such as abilities to do one’s job well, computer skills, ability to fix things around the house), work habits (for example, tendency to arrive on time, work hard, and not take overly long breaks), athletic abilities (like the ability to play tennis, fitness level, strength), creativity (for instance, musical or artistic ability), health habits (such as diet, exercise, smoking, drinking), health status (presence of medical problems), social status (type of home, income, type of job), mood (happy, excited, sad, angry, fearful), and personality (generosity, empathy, confidence, politeness, arrogance), to name just a few. 人们对彼此的判断基于许多不同的维度，包括外貌（例如，身高、体重、发色和发型、面部特征、服装、鞋子等）、智力（例如，语言能力、解决问题的技能、琐事知识等）、能力（如胜任工作的能力、计算机技能、修理家中物品的能力）、工作习惯（例如，准时到达、努力工作、不长时间休息的倾向）、运动能力（如打网球的能力、体能水平、力量）、创造力（例如，音乐或艺术才能）、健康习惯（如饮食、锻炼、吸烟、饮酒）、健康状况（是否有医疗问题）、社会地位（住房类型、收入、工作类型）、情绪（快乐、兴奋、悲伤、愤怒、恐惧）以及个性（慷慨、同理心、自信、礼貌、傲慢），仅举几例。
Most of us are far above average on some dimensions, far below average on some other dimensions, and well within average range on most dimensions. The extent to which a person criticizes you about a particular dimension probably depends on whether that person believes that particular domain is important. Although some people may criticize you for appearing nervous, it’s likely that most people couldn’t care less. If you assume others are focusing only on those dimensions in which you judge yourself to be inferior, you will continue to feel anxious and fearful around other people. 我们大多数人在某些方面远高于平均水平，在另一些方面远低于平均水平，而在大多数方面则处于平均范围内。一个人对你某个方面的批评程度，可能取决于那个人是否认为该领域重要。虽然有些人可能会因为你看起来紧张而批评你，但大多数人很可能根本不在意。如果你假设别人只关注你认为自己不足的那些方面，你就会继续在人群中感到焦虑和害怕。
Because your natural tendency may be to focus on those areas in which you feel you don’t measure up to others, it may take some practice to recognize dimensions in which you excel or in which you are similar to most other people. As a start, it may be helpful to list some of your strengths in the space provided below. 因为你的自然倾向可能是关注那些你觉得自己不如别人的方面，所以你可能需要一些练习来识别自己擅长的领域或与大多数人相似的方面。作为开始，列出你的一些优点可能会有所帮助，下面的空白处可以用来填写。
Areas of Strength 优势领域
Seeing Yourself as Others Do 像别人那样看待自己
One powerful method for challenging the overly harsh standards that you may hold for yourself is to try to see anxiety-provoking situations through another person’s perspective. What if the tables were turned and a close friend came to you for advice and 挑战你对自己可能持有的过于严苛标准的一个有效方法是尝试从他人的角度看待引发焦虑的情境。如果情况反过来，一个亲密的朋友在做完演讲后向你寻求建议和支持，会怎样呢？
support after giving a presentation? What if your friend expressed many of the same thoughts that you experience when you are in a feared social or performance situation? What might you say? 如果你的朋友表达了许多你在害怕的社交或表演场合中也会有的想法，你会怎么说？
For example, what if your friend said to you, “I totally blew my presentation. My voice was trembling, and at one point I even lost my train of thought. I’m sure I looked like a complete idiot.” How would you respond to your friend? Most likely you would say something like, “You probably did better than you think. Even if you did look anxious, people probably didn’t care.” Or, perhaps you would say something like, “I also feel very anxious during presentations. It feels very uncomfortable in the moment, but eventually it passes.” 例如，如果你的朋友对你说：“我完全搞砸了我的演讲。我的声音在颤抖，有一会儿我甚至忘了自己要说什么。我肯定看起来像个彻头彻尾的傻瓜。”你会如何回应你的朋友？很可能你会说类似这样的话：“你可能比自己想象的表现得要好。即使你看起来很紧张，人们可能也不会在意。”或者，你可能会说：“我在演讲时也会感到非常焦虑。那种感觉当时很不舒服，但最终会过去的。”
It is often much easier to challenge someone else’s anxious thoughts than it is to challenge your own. Therefore, we suggest that you try coping with your own anxious thoughts by mentally “stepping out” of the situation for a moment. Imagine that it is someone else (perhaps a close friend or family member) who is experiencing the anxiety. What might you tell him or her? Taking the perspective of a close friend may help you to challenge your own anxious thoughts. 挑战别人的焦虑想法通常比挑战自己的要容易得多。因此，我们建议你尝试通过在心理上“跳出”当前情境片刻来应对自己的焦虑想法。想象一下，是别人（也许是亲密的朋友或家人）正在经历这种焦虑。你会对他或她说些什么？采取亲密朋友的视角可能有助于你挑战自己的焦虑想法。
Another helpful method of shifting perspectives is to imagine how you might judge someone else who exhibits the same anxious behaviors that you do. For example, if you are worried that others might criticize you if your voice become shaky, you might ask yourself, “Am I critical of other people when I notice their voice shaking?” Most likely, you would not assume someone else to be incompetent, stupid, or weak just because he or she seems a bit shy or anxious in a particular situation. Well, the same is true of other people. It is unlikely that they will make such harsh judgments of you, even if they do notice that you’re anxious. 另一种有助于转换视角的方法是想象你会如何评价表现出与你相同焦虑行为的别人。例如，如果你担心别人会因为你的声音发抖而批评你，你可以问自己：“当我注意到别人声音发抖时，我会批评他们吗？”很可能，你不会因为某人在特定情境中显得有些害羞或焦虑，就认为他或她无能、愚蠢或软弱。对别人也是如此。即使别人注意到你焦虑，也不太可能对你做出如此严厉的评判。
A third strategy for shifting perspectives is to ask yourself how someone who isn’t anxious might interpret the situation you fear. For example, if you believe that it’s important to avoid parties if there is any risk at all of looking anxious, you can ask yourself how someone who isn’t anxious might view that situation. You can even imagine how a particular person (for example, a friend, relative, spouse, or therapist) might view the situation. 第三种转换视角的策略是问问自己，一个不焦虑的人会如何解读你害怕的情境。例如，如果你认为只要有一点表现出焦虑的风险就必须避免参加聚会，你可以问问自己，一个不焦虑的人会如何看待这种情况。你甚至可以想象某个特定的人（例如朋友、亲戚、配偶或治疗师）会如何看待这种情境。
To summarize, shifting your perspectives involves asking yourself three types of questions: 总结来说，转换视角涉及问自己三类问题：
What might I say to a close friend or relative who was having the same thought as me? 如果一个亲密的朋友或亲戚有和我一样的想法，我会对他说什么？
How might I view someone else who was exhibiting the same behavior as me (shaking, sweating, making a mistake, and so on)? 如果别人表现出和我一样的行为（颤抖、出汗、犯错等等），我会如何看待他？
How might someone without an anxiety problem view this situation? 没有焦虑问题的人会如何看待这种情况？
Examining the Costs and Benefits of Your Thoughts 审视你想法的利弊
As we have discussed throughout this chapter, anxious thoughts about social and performance situations are often untrue. However, sometimes they may be true (at least partially true) and still be a problem. In addition to establishing whether your thoughts are true, it’s useful to consider whether your thoughts and behaviors are helping you. If they are helpful, then they may be worth holding on to. If not, it may be time to let them go. 正如我们在本章中多次讨论的那样，关于社交和表现情境的焦虑想法往往是不真实的。然而，有时它们可能是真的（至少部分是真的），但仍然会成为问题。除了确定你的想法是否真实之外，考虑你的想法和行为是否对你有帮助也是很有用的。如果它们有帮助，那么可能值得继续保持；如果没有，可能是时候放手了。
Almost everyone wants to make a good impression and probably no one would choose to be thought of as incompetent, stupid, boring, or weak. In fact, many of the anxiety-provoking beliefs held by individuals with excessive social anxiety are similar in content to those held by people who don’t have problems with social anxiety. Beliefs such as “It is important to be liked by other people” and “It is important to make a positive impression” are often helpful beliefs that most of us develop early in life. Making a good impression on others helps us to develop friendships, get promoted at work, and impress our teachers. In fact, many rewards in life depend on being able to influence others in a positive way. 几乎每个人都希望给人留下好印象，可能没有人会选择被认为无能、愚蠢、无聊或软弱。事实上，许多过度社交焦虑者所持有的引发焦虑的信念，其内容与那些没有社交焦虑问题的人所持有的信念相似。诸如“被他人喜欢很重要”和“给人留下积极印象很重要”这样的信念，通常是我们大多数人在早期生活中形成的有益信念。给他人留下好印象有助于我们建立友谊、获得工作晋升以及给老师留下深刻印象。实际上，生活中的许多回报都依赖于能够以积极的方式影响他人。
However, excessive social anxiety is usually associated with a tendency to be overly concerned with the opinions of others-so much so that it interferes with your life and may actually lead to a more negative impression on others, particularly if you avoid important social events. The problem with the beliefs and thoughts associated with social anxiety is not necessarily that they are untrue (although sometimes they are), but rather that they are held in an exaggerated and inflexible way. For example, if the belief “I should make a good impression on others” motivates you to do a good job at work, that’s great. If, on the other hand, the same belief makes you feel paralyzed and unable to get any work done, that’s a problem. 然而，过度的社交焦虑通常与过分在意他人看法的倾向有关——以至于干扰了你的生活，甚至可能导致他人对你产生更负面的印象，尤其是当你回避重要的社交活动时。与社交焦虑相关的信念和想法的问题不一定在于它们不真实（虽然有时确实如此），而在于它们被以夸大且僵化的方式持有。例如，如果“我应该给别人留下好印象”这一信念激励你在工作中表现出色，那很好。另一方面，如果同样的信念让你感到瘫痪，无法完成任何工作，那就是个问题。
In addition to establishing the accuracy of your anxious beliefs and predictions, it may also be helpful to consider whether your thoughts and behaviors are helping you. Following is a form that you can use for this exercise. If you are unsure about whether a particular anxiety-provoking thought is true or false, try examining the costs and benefits of constantly dwelling on the thought. How would the quality of your life improve if you didn’t have the thought? 除了确认你焦虑的信念和预测的准确性外，考虑你的想法和行为是否对你有帮助也可能很有益。以下是一份你可以用来进行此练习的表格。如果你不确定某个引发焦虑的想法是真还是假，试着审视不断沉溺于该想法的代价和收益。如果没有这个想法，你的生活质量会如何改善？
Describe Your Anxious Thought or Prediction 描述你的焦虑想法或预测
List the Benefits of Having That Anxious Thought or Prediction 列出拥有该焦虑想法或预测的好处
List the Costs of Having That Anxious Thought or Prediction 列出拥有该焦虑想法或预测的代价
Rational Coping Statements 理性应对语句
At the height of your fear, it may be difficult to challenge your anxious thoughts using some of the techniques described in this chapter. You may find that your attention is completely focused on trying to get through the situation, and it may seem impossible to think logically. Rational coping statements are relatively easy to use and don’t require the same level of logical analysis as other techniques, such as examining the evidence and evaluating the costs and benefits of your anxious thoughts. Rational coping statements are short “nonanxious” sentences that may help to combat your anxious thinking. Examples include the following: 在你恐惧感最强烈的时候，可能很难用本章中描述的一些技巧来挑战你的焦虑思维。你可能会发现自己的注意力完全集中在努力度过眼前的情境上，似乎无法进行理性思考。理性应对语句相对容易使用，不需要像其他技巧那样进行深入的逻辑分析，比如审视证据和评估焦虑思维的利弊。理性应对语句是简短的“非焦虑”句子，可能有助于对抗你的焦虑思维。例子包括：
It would be manageable if qquad\qquad didn’t like me. 如果 qquad\qquad 不喜欢我，我也能应付得来。
It’s okay to blush in front of others. 在别人面前脸红是没关系的。
Panic attacks are uncomfortable but not dangerous. 惊恐发作虽然不舒服，但并不危险。
It is okay to look anxious during a presentation. 在演讲时表现出焦虑是可以的。
People don’t seem to notice my shaky hands. 人们似乎没有注意到我颤抖的手。
You may find it helpful to write or type several coping statements on an index card and carry the card with you as a reminder. When you are in an anxiety-provoking situation, you can take the card out of your wallet or purse and remind yourself of one or more of these statements, thereby combating your anxious thoughts. Choose statements that are most relevant to you. Also, choose statements that are believable. For example, there is no point telling yourself, “I am not going to be anxious” if you always feel anxious when giving speeches and you are about to give a speech. A more believable alternative is, “It’s not the end of the world if I become anxious.” 你可能会发现，在索引卡片上写下或打字几条应对语句并随身携带这张卡片作为提醒会很有帮助。当你处于引发焦虑的情境中时，可以从钱包或包里拿出这张卡片，提醒自己其中一条或多条语句，从而对抗焦虑的想法。选择与你最相关的语句。同时，选择你能相信的语句。例如，如果你在演讲时总是感到焦虑，而你即将进行演讲，那么告诉自己“我不会感到焦虑”是没有意义的。一个更可信的替代语句是，“即使我感到焦虑，也不是世界末日。”
In the following spaces, record five rational coping statements that are relevant to your own particular anxious beliefs. 在下面的空白处，写下五条与你自身特定焦虑信念相关的理性应对语句。
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qquad\qquad
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Behavioral Experiments 行为实验
Cognitive therapy involves examining the validity of your beliefs and thoughts in the same way that a scientist examines the validity of a scientific theory or hypothesis. In fact, the experiment is the most powerful strategy scientists have to test their own beliefs. In cognitive therapy for social anxiety, experiments involve challenging anxious beliefs by setting up small behavioral tests to see whether a belief is in fact valid. Through a series of repeated behavioral experiments, it is likely that you will disprove many of the beliefs and predictions that contribute to your fear and anxiety. Some examples of specific experiments that can be used to test the validity of various anxiety-provoking thoughts are listed below. 认知疗法涉及以科学家检验科学理论或假设有效性的方式来检验你的信念和想法的有效性。事实上，实验是科学家用来测试自己信念的最有力策略。在社交焦虑的认知疗法中，实验包括通过设置小型行为测试来挑战焦虑的信念，以验证这些信念是否真实有效。通过一系列反复的行为实验，你很可能会推翻许多导致你恐惧和焦虑的信念和预测。下面列出了一些可以用来测试各种引发焦虑想法有效性的具体实验示例。
Anxiety-Provoking Thought 引发焦虑的想法
It would be terrible to have my hand shake while I hold a glass of water. 当我拿着一杯水时，手抖会很糟糕。
Example of Behavioral Experiment 行为实验示例
Purposely shake your hand while you hold a glass of water. For a true test of your beliefs, let the water spill all over you! Then see if it really is so terrible. 故意在手里拿着一杯水时摇晃手。为了真正检验你的信念，让水洒得到处都是！然后看看这是否真的那么糟糕。
Go to the job interview and see what happens. 去参加工作面试，看看会发生什么。
Do something to draw attention to yourself. For example, arrive to class late, drop your keys, wear your shirt inside out, or knock over some unbreakable items in a supermarket. 做一些引起别人注意的事情。例如，上课迟到，掉钥匙，穿反衬衫，或者在超市里撞倒一些不易破碎的物品。
Line up at a store and after your items have been rung up, explain to the cashier that you have forgotten your money. 在商店排队结账后，向收银员解释你忘带钱了。
Invite your coworker for dinner and check out his or her reaction. 邀请你的同事共进晚餐，观察他或她的反应。
When selecting possible experiments, try to choose practices in which you have little to lose. For example, don’t tell your boss how much you hate him, just to see what happens! Try to select experiments in which the worst that will happen is possible discomfort or temporary embarrassment. Remember that the more social risks you take, the more often they will pay off. Along the way, however, you will also experience rejection from time to time. If you don’t take risks, you will never be rejected-but you will also 在选择可能的实验时，尽量选择那些你几乎没有损失的做法。例如，不要告诉你的老板你有多讨厌他，只是为了看看会发生什么！尝试选择那些最坏结果可能只是感到不适或暂时尴尬的实验。记住，你承担的社交风险越多，收获的机会也越多。然而，在这个过程中，你也会时不时地遭遇拒绝。如果你不冒险，你永远不会被拒绝——但你也会
never experience the benefits of taking social risks, including improved relationships, a better job, and other possible rewards. 永远无法体验承担社交风险的好处，包括改善人际关系、获得更好的工作以及其他可能的回报。
In the spaces below, imagine and record some experiments you could try in order to test out your particular anxious thoughts. In the first column, write down your anxious belief. In the second column, design a small experiment that will provide a good test of whether your belief is true. 在下面的空白处，想象并记录一些你可以尝试的实验，以测试你特定的焦虑想法。在第一栏中，写下你的焦虑信念。在第二栏中，设计一个小实验，以很好地检验你的信念是否真实。
Anxious Thought 焦虑想法 qquad\qquad qquad\qquad qquad\qquad qquad\qquad qquad\qquad
The next few chapters discuss strategies for confronting the very situations and feelings that you fear. As you will see, exposure to feared situations is actually a type of behavioral experiment. By repeatedly exposing yourself to situations that make you anxious, you will learn that your fears often don’t materialize. 接下来的几章将讨论面对你害怕的情境和感受的策略。正如你将看到的，暴露于害怕的情境实际上是一种行为实验。通过反复让自己暴露在让你焦虑的情境中，你将学会你的恐惧往往不会成真。
USING A THOUGHT RECORD OR COGNITIVE DIARY 使用思维记录或认知日记
Throughout this chapter, we have included various forms and diaries to be used for challenging anxious thoughts. In this section, we now provide a more general Social Anxiety Thought Record that can be used whenever you experience anxiety in a social situation. Unlike the other forms in this chapter, which are each designed for use with a particular technique (examining the evidence, overcoming catastrophic thinking, and so on), the Social Anxiety Thought Record is designed to be used with any of the cognitive strategies. At the end of this chapter is a blank form, as well as a completed sample. 在本章中，我们提供了各种表格和日记，用于挑战焦虑的想法。在本节中，我们将提供一个更通用的社交焦虑思维记录表，适用于你在社交场合中感到焦虑时使用。与本章中其他针对特定技巧（如审视证据、克服灾难性思维等）设计的表格不同，社交焦虑思维记录表可配合任何认知策略使用。本章末尾附有一份空白表格和一份填写示例。
It really doesn’t matter which form you use to record and change your thoughts. You can use the forms provided in this chapter, or you can design your own. The diaries in this chapter are only suggestions. The main point of these diaries is to get you into the habit of paying attention to your thoughts and actively trying to change them. Once the new patterns of thinking become second nature, it will no longer be necessary to record your thoughts on paper. In the meantime, we recommend that you use some type of diary or form several times per week after encountering feared social or performance situations. The best times to complete the forms are either before entering the situation (as a way of preparing for the encounter) or immediately afterward (as a way of challenging any anxious thoughts that occurred while you were in the situation). 使用哪种形式来记录和改变你的想法其实并不重要。你可以使用本章提供的表格，也可以自己设计。这里的日记只是建议。写日记的主要目的是让你养成关注自己想法并积极尝试改变它们的习惯。一旦新的思维模式变成了第二天性，就不再需要把想法写在纸上了。与此同时，我们建议你在遇到害怕的社交或表演场合后，每周使用某种日记或表格几次。填写表格的最佳时间是在进入情境之前（作为准备）或紧接着情境结束后（作为挑战在情境中产生的焦虑想法的方式）。
Instructions for Completing the Social Anxiety Thought Record 填写社交焦虑思维记录表的说明
Column 1: Date and Time 第一栏：日期和时间
Record the date and time. 记录日期和时间。
Column 2: Situation 第 2 栏：情境
Describe the situation or trigger for your fear. Typical examples might include the following: 描述引发你恐惧的情境或触发因素。典型的例子可能包括以下内容：
Gave a presentation 做了一个演讲
Went to a meeting 参加了一个会议
Person was watching me on the subway 有人在地铁上看着我
Ate lunch with a coworker 和同事一起吃了午饭
I was blushing 我脸红了
My hands shook in front of my boss 我在老板面前手抖了
Went to a party 去参加了一个派对
Had to do an oral book-report for class 必须为课堂做一个口头读书报告
Was introduced to my sister’s new boyfriend 被介绍给我姐姐的新男友
Went on a blind date 去了一次相亲约会
Column 3: Anxiety-Provoking Thoughts and Predictions 第三栏：引发焦虑的想法和预测
In the third column, list any anxious thoughts that occur in response to the situation and triggers reported in column 2. Usually these thoughts will be predictions of danger, embarrassment, and so on. Often these thoughts will be automatic or almost unconscious. It will take practice to identify them. Try to come up with very specific thoughts. A thought such as, “Something bad will happen” is too vague. Typical examples of specific anxious thoughts include the following: 在第三栏中，列出对第二栏中报告的情境和触发因素产生的任何焦虑想法。通常这些想法会是对危险、尴尬等的预测。这些想法往往是自动的或几乎无意识的。识别它们需要练习。尽量想出非常具体的想法。像“会发生不好的事情”这样的想法太模糊了。具体的焦虑想法的典型例子包括：
People will notice my blushing and think I am strange 别人会注意到我脸红，觉得我很奇怪
People will notice that I am nervous 别人会注意到我很紧张
I will make a fool of myself 我会出丑
People will think I am stupid 别人会认为我很愚蠢
People will see me for the idiot I really am 别人会看到我其实是个白痴
People will think I’m ugly 别人会觉得我很丑陋
I will have to leave the situation 我将不得不离开这种情况
I am incompetent and clumsy 我无能且笨拙
I need an alcoholic drink to feel comfortable 我需要一杯酒才能感到舒适
People can always tell how I am feeling 人们总能看出我的感受
Anxiety is a sign of weakness 焦虑是软弱的表现
I’ll be viewed as boring 我会被认为很无聊
People will not like me 别人不会喜欢我
I will have nothing to say 我将无话可说
Column 4: Anxiety Before (0-100) 第 4 栏：事前焦虑（0-100）
Rate your anxiety level before countering your anxiety-provoking thoughts. Use a 0 to 100 point scale, where 0=0= no anxiety and 100=100= extreme anxiety. 在应对引发焦虑的想法之前，评估你的焦虑程度。使用 0 到 100 的评分标准，其中 0=0= 表示无焦虑， 100=100= 表示极度焦虑。
Column 5: Alternative Thoughts and Predictions 第 5 栏：替代想法和预测
Record examples of alternative thoughts and predictions. For example, if you believe that people will think you are strange if you blush, alternative predictions might include such thoughts as (1) nobody will notice my blushing, (2) people who notice my blushing will think I am hot or not feeling well, and (3) people who notice my blushing will think nothing of it. 记录替代想法和预测的例子。例如，如果你认为脸红会让别人觉得你很奇怪，替代预测可能包括以下想法：（1）没人会注意到我脸红，（2）注意到我脸红的人会认为我很热或者身体不舒服，（3）注意到我脸红的人不会在意。
Column 6: Evidence and Realistic Conclusions 第 6 栏：证据与现实结论
Consider the evidence for your anxiety-provoking thoughts as well as your alternative thoughts. For example, if you fear blushing, you might record your observations that most people don’t mention that they notice your blushing, and that even when people do notice that you are blushing, they still seem to enjoy your company and they still treat you well. In this column, you should also record a realistic conclusion based on the evidence. For example, you might record, “Many people don’t seem to notice my blushing, and even when someone does notice it, there are no real consequences other than my temporary embarrassment.” 考虑引发你焦虑的想法以及你的替代想法的证据。例如，如果你害怕脸红，你可以记录你的观察：大多数人并没有提到他们注意到你脸红，即使有人注意到了你脸红，他们仍然似乎喜欢与你相处，并且对你态度良好。在这一栏中，你还应根据证据记录一个现实的结论。例如，你可以记录：“许多人似乎没有注意到我脸红，即使有人注意到了，也没有真正的后果，除了我暂时的尴尬。”
Column 7: Anxiety After (0-100) 第 7 栏：事后焦虑（0-100）
Rate your anxiety level after countering your anxiety-provoking thoughts. Use a 0 to 100 point scale, where 0=0= no anxiety and 100=100= extreme anxiety. 在反驳引发焦虑的想法后，评估你的焦虑水平。使用 0 到 100 的评分标准，其中 0=0= 表示无焦虑， 100=100= 表示极度焦虑。
INTEGRATING COGNITIVE STRATEGIES INTO YOUR TREATMENT PLAN 将认知策略整合到您的治疗计划中
The cognitive techniques described in this chapter are not meant to be used on their own. Rather, they should be used as part of a comprehensive treatment plan that includes exposure to feared situations. Exposure-based treatments are discussed in chapters 7 through 9. We recommend that you first practice the cognitive techniques for a few weeks before formally beginning exposure practices. Learning to manage your anxiety by changing your thinking will help you when confronting the situations that you fear. In addition to exposure and cognitive therapy, your treatment may also include medication (see chapter 5) and social-skills practices (see chapter 10), depending on your own personal needs and preferences. 本章所述的认知技巧并非单独使用。相反，它们应作为包含暴露于恐惧情境的综合治疗计划的一部分。基于暴露的治疗在第 7 至 9 章中有讨论。我们建议您先练习认知技巧几周，然后再正式开始暴露练习。通过改变思维来管理焦虑，将有助于您面对恐惧的情境。除了暴露和认知疗法外，您的治疗还可能包括药物治疗（见第 5 章）和社交技能训练（见第 10 章），具体取决于您的个人需求和偏好。
A WORD TO SIGNIFICANT OTHERS, FRIENDS, AND FAMILY MEMBERS 致重要他人、朋友和家人的话
If you are working with a loved one who is trying to overcome his or her social anxiety, you can help him or her to change anxiety-provoking thoughts into more realistic thoughts by engaging in calm, logical discussions about the situations he or she fears. This process should always be done in a supportive way, and you should be careful not to put your loved one down for having anxiety-provoking beliefs (after all, we all have irrational thoughts from time to time). You should also be careful not to tell your loved one what he or she should be thinking. Rather, your loved one should draw his or her own conclusions based on the evidence. Finally, remember that your role is to be supportive-not to nag or pressure your loved one into making changes or to argue about how to interpret anxiety-provoking situations. You and your loved one should discuss what role he or she would like you to have, and how you can best facilitate the process of change. 如果你正在帮助一位亲人克服社交焦虑，你可以通过与他或她进行冷静、合乎逻辑的讨论，帮助他或她将引发焦虑的想法转变为更现实的想法。这一过程应始终以支持的方式进行，你应当小心不要因为亲人有引发焦虑的信念而贬低他或她（毕竟，我们都有时会有非理性的想法）。你还应当避免告诉亲人他或她应该怎么想。相反，亲人应当根据证据自行得出结论。最后，请记住你的角色是支持者——而不是唠叨或施压亲人去改变，或争论如何解读引发焦虑的情境。你和亲人应当讨论他或她希望你扮演什么角色，以及你如何能最好地促进改变的过程。
TROUBLESHOOTING 故障排除
Problem: I have difficulty identifying my anxious thoughts. 问题：我很难识别自己的焦虑想法。
Solution: Ask yourself questions such as, “What might qquad\qquad think about me?” and “What do I think will happen in this situation?” If, after trying to answer these questions, you are still unable to identify your anxious beliefs, try to detect your thoughts while you are actually in the situation you fear. If you are unable to identify specific thoughts and predictions, don’t worry. You can still benefit from the exposure-based strategies discussed in chapters 7 through 9. 解决方案：问自己一些问题，比如“ qquad\qquad 可能会怎么想我？”以及“我认为在这种情况下会发生什么？”如果在尝试回答这些问题后，你仍然无法识别出自己的焦虑信念，试着在你实际处于害怕的情境中时，去察觉自己的想法。如果你无法识别出具体的想法和预测，也不用担心。你仍然可以从第 7 至第 9 章讨论的基于暴露的策略中受益。
Problem: 问题：
I have difficulty believing the alternative, nonanxious, rational thoughts. 我很难相信那些替代的、非焦虑的、理性的想法。
Solution: 解决方案：
Sometimes the cognitive techniques seem superficial when a person first starts to use them. Over time, the new nonanxious thoughts should become more believable. If not, the exposure-based strategies (chapters 7 through 9) are among the most powerful methods for changing anxious thoughts and will likely help. Sometimes, changing thoughts through firsthand experience in a feared situation is more effective than trying to change thoughts by simply trying to think differently. 有时候，当一个人刚开始使用认知技巧时，这些技巧似乎显得表面化。随着时间的推移，新的非焦虑性想法应该会变得更有说服力。如果没有，基于暴露的策略（第 7 至 9 章）是改变焦虑想法的最有效方法之一，可能会有所帮助。有时，通过在恐惧情境中的亲身体验来改变想法，比单纯尝试用不同的思维方式来改变想法更有效。
Problem: 问题：
When I am in a social situation, I am too anxious to think clearly, so I can't use the cognitive strategies. 当我处于社交场合时，我太焦虑以至于无法清晰思考，因此无法使用认知策略。
Solution: 解决方案：
Try using the cognitive strategies before you enter the situation. If this is not practical, try using them after you have been in the situation for a while (your fear should decrease over time) or even after leaving the situation. 尝试在进入情境之前使用认知策略。如果这不现实，可以尝试在你处于情境一段时间后使用它们（你的恐惧应该会随着时间减少），甚至在离开情境后使用。
Problem: 问题：
I can't be bothered completing the monitoring forms. They are confusing, and they take too long to complete. 我懒得填写监控表格。它们很混乱，而且填写起来太费时间。
Solution: 解决方案：
There are many different ways to learn the techniques described in this chapter. The forms and diaries are designed to make the process easier. However, if they are getting in the way of using the strategies, try developing a simpler form (for example, you may want to use a twocolumn form-with one column for recording your anxious thoughts and another column for recording your new nonanxious thoughts). Alternatively, you can even forget about the forms and diaries and simply use the techniques in your head. 学习本章所述技巧的方法有很多种。表格和日记的设计是为了让这个过程更简单。然而，如果它们妨碍了你使用这些策略，可以尝试开发一个更简单的表格（例如，你可以使用一个两栏的表格——一栏记录你的焦虑想法，另一栏记录你新的非焦虑想法）。或者，你甚至可以忘记表格和日记，直接在脑海中使用这些技巧。
Problem: I have difficulty believing the alternative, nonanxious, rational thoughts.
Solution: Sometimes the cognitive techniques seem superficial when a person first starts to use them. Over time, the new nonanxious thoughts should become more believable. If not, the exposure-based strategies (chapters 7 through 9) are among the most powerful methods for changing anxious thoughts and will likely help. Sometimes, changing thoughts through firsthand experience in a feared situation is more effective than trying to change thoughts by simply trying to think differently.
Problem: When I am in a social situation, I am too anxious to think clearly, so I can't use the cognitive strategies.
Solution: Try using the cognitive strategies before you enter the situation. If this is not practical, try using them after you have been in the situation for a while (your fear should decrease over time) or even after leaving the situation.
Problem: I can't be bothered completing the monitoring forms. They are confusing, and they take too long to complete.
Solution: There are many different ways to learn the techniques described in this chapter. The forms and diaries are designed to make the process easier. However, if they are getting in the way of using the strategies, try developing a simpler form (for example, you may want to use a twocolumn form-with one column for recording your anxious thoughts and another column for recording your new nonanxious thoughts). Alternatively, you can even forget about the forms and diaries and simply use the techniques in your head.| Problem: | I have difficulty believing the alternative, nonanxious, rational thoughts. |
| :--- | :--- |
| Solution: | Sometimes the cognitive techniques seem superficial when a person first starts to use them. Over time, the new nonanxious thoughts should become more believable. If not, the exposure-based strategies (chapters 7 through 9) are among the most powerful methods for changing anxious thoughts and will likely help. Sometimes, changing thoughts through firsthand experience in a feared situation is more effective than trying to change thoughts by simply trying to think differently. |
| Problem: | When I am in a social situation, I am too anxious to think clearly, so I can't use the cognitive strategies. |
| Solution: | Try using the cognitive strategies before you enter the situation. If this is not practical, try using them after you have been in the situation for a while (your fear should decrease over time) or even after leaving the situation. |
| Problem: | I can't be bothered completing the monitoring forms. They are confusing, and they take too long to complete. |
| Solution: | There are many different ways to learn the techniques described in this chapter. The forms and diaries are designed to make the process easier. However, if they are getting in the way of using the strategies, try developing a simpler form (for example, you may want to use a twocolumn form-with one column for recording your anxious thoughts and another column for recording your new nonanxious thoughts). Alternatively, you can even forget about the forms and diaries and simply use the techniques in your head. |
A SUMMARY GUIDE TO CHALLENGING THOUGHTS 挑战思维的总结指南
This chapter includes a large number of suggestions and strategies for identifying and changing your anxious thoughts. Now that you have had a chance to read through the chapter and complete some of the exercises, we encourage you to continue using the cognitive techniques to cope with your social and performance anxiety. Generally, using the cognitive strategies will involve the following steps: 本章包含了大量识别和改变焦虑思维的建议和策略。现在你已经有机会阅读本章并完成了一些练习，我们鼓励你继续使用认知技巧来应对社交和表现焦虑。通常，使用认知策略包括以下步骤：
Identify your anxious thoughts, predictions, and interpretations. 识别你的焦虑想法、预测和解释。
Examine the validity of your anxious predictions using some of the techniques described in this chapter (such as examining the evidence, taking the perspective of others, examining the costs and benefits of your thoughts, conducting behavioral experiments). Are your predictions realistic? For example, will others really think qquad\qquad about you? 使用本章中描述的一些技巧（例如审查证据、换位思考、评估你想法的利弊、进行行为实验）来检验你焦虑预测的有效性。你的预测现实吗？例如，别人真的会像你想的那样 qquad\qquad 看待你吗？
Examine the validity of your catastrophic thoughts by asking the question, “So what if my anxious thoughts are true?” For example, “What if a few people in the audience really think my presentation is awful? How might I cope with that?” 通过问自己“如果我的焦虑想法是真的，那又怎样？”来检验你灾难性想法的有效性。例如，“如果观众中有几个人真的觉得我的演讲很糟糕，我该如何应对？”
Use the Social Anxiety Thought Record to identify and challenge your anxious thoughts on paper. 使用社交焦虑思维记录表，在纸上识别并挑战你的焦虑想法。
The Shyness & Social Anxiety Workbook 《害羞与社交焦虑工作手册》
Noncatastrophic Responses (What if my thoughts come true?)
(сәлид әшол здубิпочᄀ кш н! ұеч м)
Noncatastrophic Responses (What if my thoughts come true?)
(сәлид әшол здубิпочᄀ кш н! ұеч м)| Noncatastrophic Responses (What if my thoughts come true?) |
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| (сәлид әшол здубิпочᄀ кш н! ұеч м) |
Decatastrophizing Form 去灾难化表格
焦虑的想法和预测（我认为会发生什么？）（силири）[!м мичн ор нечли)
Anxious Thoughts and Predictions (What do I think will happen?)
(силири) [!м мичн ор нечली)
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Anxious Thoughts and Predictions (What do I think will happen?)
(силири) [!м мичн ор нечली),,| Anxious Thoughts and Predictions (What do I think will happen?) |
| :--- |
| (силири) [!м мичн ор нечली) <br> <br> |
"Noncatastrophic Responses (What if my thoughts come true?)
(сәлид әшол здубิпочᄀ кш н! ұеч м)" https://cdn.mathpix.com/cropped/2025_07_28_ec4795ac2f3cf5dfe9f6g-149.jpg?height=557&width=1047&top_left_y=281&top_left_x=473
Decatastrophizing Form "Anxious Thoughts and Predictions (What do I think will happen?)
(силири) [!м мичн ор нечली),," | | Noncatastrophic Responses (What if my thoughts come true?) <br> (сәлид әшол здубิпочᄀ кш н! ұеч м) |  |
| :--- | :--- | :--- |
| Decatastrophizing Form | Anxious Thoughts and Predictions (What do I think will happen?) <br> (силири) [!м мичн ор нечली) <br> <br> | |
Social Anxiety Thought Record 社交焦虑思维记录
Date and Time 日期和时间
Situation 情境
Anxiety-Provoking Thoughts and Predictions 引发焦虑的想法和预测
Anxiety Before (0-100) 事前焦虑程度（0-100）
Alternative Thoughts and Predictions 替代性想法和预测
Evidence and Realistic Conclusions 证据和现实结论
Anxiety After (0-100) 焦虑程度（0-100）
Date and Time Situation Anxiety-Provoking Thoughts and Predictions Anxiety Before (0-100) Alternative Thoughts and Predictions Evidence and Realistic Conclusions Anxiety After (0-100)
| Date and Time | Situation | Anxiety-Provoking Thoughts and Predictions | Anxiety Before (0-100) | Alternative Thoughts and Predictions | Evidence and Realistic Conclusions | Anxiety After (0-100) |
| :--- | :--- | :--- | :--- | :--- | :--- | :--- |
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Social Anxiety Thought Record—Completed Sample 社交焦虑思维记录——完成示例
Date and Time 日期和时间
Situation 情境
Anxiety-Provoking Thoughts and Predictions 引发焦虑的想法和预测
Anxiety Before (0-100) 事前焦虑程度（0-100）
Alternative Thoughts and Predictions 替代性想法和预测
Evidence and Realistic Conclusions 证据和现实结论
Anxiety After (0-100) 焦虑程度（0-100）
April 3, 2 PM 4 月 3 日，下午 2 点
Meeting at work 在工作会议上
I will say something stupid; people will think I'm an idiot. 我会说些愚蠢的话；人们会认为我是个白痴。
90
I will say something intelligent. I will say something that is neither stupid nor intelligent. Some people will think I'm smart; some people may think I am of average intelligence. Whatever I say won't change what my coworkers already think about my intelligence. 我会说些聪明的话。我也会说些既不愚蠢也不聪明的话。有些人会认为我很聪明；有些人可能认为我智力一般。无论我说什么，都不会改变同事们对我智力的看法。
My boss asked me to speak at the meeting, so she must think I have something worthwhile to say. Everyone says stupid things from time to time, and there is no reason to think that I shouldn't also say dumb things sometimes. Nothing terrible will bappen if I say something stupid. Everyone in the room already knows me. Even if someone thinks I am stupid, it won't be the end of the world. 我的老板让我在会议上发言，所以她一定认为我有值得说的内容。每个人都会时不时说些愚蠢的话，没有理由认为我不应该偶尔说些傻话。如果我说了愚蠢的话，也不会发生什么可怕的事情。会议室里的每个人都已经认识我了。即使有人认为我愚蠢，也不会是世界末日。
50
April 5, 7 PM 4 月 5 日，晚上 7 点
Eating dinner with a friend; my bands are shaking 和朋友一起吃晚饭；我的手臂在发抖
My shaking bands will be noticeable. My friend will think that I am nervous and will see that as a weakness. 我发抖的手臂会很明显。我的朋友会认为我很紧张，并把这看作是一种弱点。
70
Maybe my friend won't notice my bands shaking. Even if he notices, be may not think it is due to anxiety. Even if he thinks it is due to anxiety, be may not see it as a weakness. 也许我的朋友不会注意到我的手臂在发抖。即使他注意到了，也可能不会认为这是因为焦虑。即使他认为这是因为焦虑，也可能不会把它看作是一种弱点。
I bave known my friend for years. He knows that I get nervous sometimes, and be still wants to spend time with me. He gets nervous in situations that don't bother me (he is afraid of flying). I bave the right to bave shaky bands sometimes! 我认识我的朋友很多年了。他知道我有时会紧张，但仍然想和我共度时光。他在一些我不觉得烦恼的情况下会紧张（他害怕飞行）。我有权利有时手发抖！
45
Date and Time Situation Anxiety-Provoking Thoughts and Predictions Anxiety Before (0-100) Alternative Thoughts and Predictions Evidence and Realistic Conclusions Anxiety After (0-100)
April 3, 2 PM Meeting at work I will say something stupid; people will think I'm an idiot. 90 I will say something intelligent. I will say something that is neither stupid nor intelligent. Some people will think I'm smart; some people may think I am of average intelligence. Whatever I say won't change what my coworkers already think about my intelligence. My boss asked me to speak at the meeting, so she must think I have something worthwhile to say. Everyone says stupid things from time to time, and there is no reason to think that I shouldn't also say dumb things sometimes. Nothing terrible will bappen if I say something stupid. Everyone in the room already knows me. Even if someone thinks I am stupid, it won't be the end of the world. 50
April 5, 7 PM Eating dinner with a friend; my bands are shaking My shaking bands will be noticeable. My friend will think that I am nervous and will see that as a weakness. 70 Maybe my friend won't notice my bands shaking. Even if he notices, be may not think it is due to anxiety. Even if he thinks it is due to anxiety, be may not see it as a weakness. I bave known my friend for years. He knows that I get nervous sometimes, and be still wants to spend time with me. He gets nervous in situations that don't bother me (he is afraid of flying). I bave the right to bave shaky bands sometimes! 45| Date and Time | Situation | Anxiety-Provoking Thoughts and Predictions | Anxiety Before (0-100) | Alternative Thoughts and Predictions | Evidence and Realistic Conclusions | Anxiety After (0-100) |
| :--- | :--- | :--- | :--- | :--- | :--- | :--- |
| April 3, 2 PM | Meeting at work | I will say something stupid; people will think I'm an idiot. | 90 | I will say something intelligent. I will say something that is neither stupid nor intelligent. Some people will think I'm smart; some people may think I am of average intelligence. Whatever I say won't change what my coworkers already think about my intelligence. | My boss asked me to speak at the meeting, so she must think I have something worthwhile to say. Everyone says stupid things from time to time, and there is no reason to think that I shouldn't also say dumb things sometimes. Nothing terrible will bappen if I say something stupid. Everyone in the room already knows me. Even if someone thinks I am stupid, it won't be the end of the world. | 50 |
| April 5, 7 PM | Eating dinner with a friend; my bands are shaking | My shaking bands will be noticeable. My friend will think that I am nervous and will see that as a weakness. | 70 | Maybe my friend won't notice my bands shaking. Even if he notices, be may not think it is due to anxiety. Even if he thinks it is due to anxiety, be may not see it as a weakness. | I bave known my friend for years. He knows that I get nervous sometimes, and be still wants to spend time with me. He gets nervous in situations that don't bother me (he is afraid of flying). I bave the right to bave shaky bands sometimes! | 45 |
April 7, 3 PM 4 月 7 日，下午 3 点
Returning an item to a store 退货
The cashier will think I'm stupid for buying this item in the first place. I won't be clear when trying to explain what I want to do. The cashier won't let me return the item, and I won't know bow to respond. 收银员会觉得我一开始买这个东西很傻。我在试图解释我想做什么时不会说清楚。收银员不会让我退货，我也不知道该如何应对。
70
The casbier will not think I am stupid. I will be able to explain what I want to do. The casbier will allow me to return the item. Even if I am anxious, I will be able to cope with this situation. 收银员不会认为我很笨。我能够解释我想做什么。收银员会允许我退货。即使我感到焦虑，我也能应对这种情况。
I bave returned items to stores before, and it always seems to work out. Chances are that it will work out this time, too. Returns are allowed within 30 days, so I bave the right to return this item. Even if I seem nervous, the cashier doesn't have the right to turn down my request. If I can't think of the right words, I can just take my time until the words come to me. 我以前也退过商店的商品，而且总是能顺利解决。这次很可能也会顺利解决。退货期限是 30 天内，所以我有权退这件商品。即使我看起来紧张，收银员也无权拒绝我的请求。如果我想不出合适的话，我可以慢慢来，直到想出合适的词语。
20
April 7, 3 PM Returning an item to a store The cashier will think I'm stupid for buying this item in the first place. I won't be clear when trying to explain what I want to do. The cashier won't let me return the item, and I won't know bow to respond. 70 The casbier will not think I am stupid. I will be able to explain what I want to do. The casbier will allow me to return the item. Even if I am anxious, I will be able to cope with this situation. I bave returned items to stores before, and it always seems to work out. Chances are that it will work out this time, too. Returns are allowed within 30 days, so I bave the right to return this item. Even if I seem nervous, the cashier doesn't have the right to turn down my request. If I can't think of the right words, I can just take my time until the words come to me. 20| April 7, 3 PM | Returning an item to a store | The cashier will think I'm stupid for buying this item in the first place. I won't be clear when trying to explain what I want to do. The cashier won't let me return the item, and I won't know bow to respond. | 70 | The casbier will not think I am stupid. I will be able to explain what I want to do. The casbier will allow me to return the item. Even if I am anxious, I will be able to cope with this situation. | I bave returned items to stores before, and it always seems to work out. Chances are that it will work out this time, too. Returns are allowed within 30 days, so I bave the right to return this item. Even if I seem nervous, the cashier doesn't have the right to turn down my request. If I can't think of the right words, I can just take my time until the words come to me. | 20 |
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CHAPTER 7 第 7 章
Confronting Your Fears Through Exposure 通过暴露疗法面对你的恐惧
Chapter 6 provided a detailed overview of cognitive strategies that have been shown to be useful for changing anxious patterns of thinking. Almost all of the cognitive techniques involve learning to think differently about social and performance situations by (1) broadening the possible range of interpretations and beliefs that you can hold for a particular social situation, and (2) considering all the evidence before assuming that a specific thought is true. 第六章详细介绍了已被证明对改变焦虑思维模式有用的认知策略。几乎所有的认知技巧都涉及学习以不同的方式看待社交和表现情境，具体包括（1）拓宽你对特定社交情境可能持有的解释和信念范围，以及（2）在假设某个特定想法为真之前，考虑所有的证据。
This chapter provides an introduction to a number of techniques that are useful for changing the behaviors that maintain your anxious beliefs and feelings. Essentially, these strategies involve confronting your fears directly by exposing yourself to the situations and the feelings that you currently fear and avoid. This chapter starts with a review of the behaviors that contribute to social anxiety and a summary of the strategies that can be used to change these behaviors. The remainder of the chapter provides more detailed descriptions of the underlying principles of exposure and the best ways of conducting exposure-based therapy. 本章介绍了多种有助于改变维持你焦虑信念和感受的行为的技巧。基本上，这些策略涉及通过让自己直接面对恐惧，暴露于你当前害怕和回避的情境及感受中。本章首先回顾了导致社交焦虑的行为，并总结了可用于改变这些行为的策略。章节的其余部分则更详细地描述了暴露的基本原理以及进行基于暴露的治疗的最佳方法。
Chapters 8 and 9 build directly on the content of this introductory chapter by providing more in-depth instructions for exposure to social situations (chapter 8) and exposure to feared sensations (chapter 9). The exercises described in chapters 7 through 9 should be used after you have had a chance to practice some of the cognitive methods described in chapter 6. We recommend that you begin to learn about exposure by reading chapters 7 and 8 and that you practice the situational exposure exercises for at least three to five weeks before moving on to chapter 9 . Then, we suggest that you read chapter 9 and make some attempts to expose yourself to feared sensations, if these exercises are relevant to you. As reviewed in chapter 9, exposure to physical sensations may be useful if you 第 8 章和第 9 章直接建立在本导论章节的内容基础上，提供了更深入的社交情境暴露（第 8 章）和恐惧感官暴露（第 9 章）的指导。第 7 至第 9 章中描述的练习应在你有机会练习第 6 章中介绍的一些认知方法之后使用。我们建议你先通过阅读第 7 章和第 8 章来开始了解暴露，并且至少练习情境暴露练习三到五周，然后再进入第 9 章。接着，我们建议你阅读第 9 章，并尝试进行恐惧感官的暴露练习，如果这些练习与你相关的话。如第 9 章所述，暴露于身体感官可能会有帮助，如果你…
are fearful of experiencing particular feelings (for instance, sweating, shaking, blushing, racing heart) associated with being anxious or nervous. If you are not fearful of these behaviors, then the strategies described in chapter 9 will not be as important. 害怕体验与焦虑或紧张相关的特定感觉（例如出汗、颤抖、脸红、心跳加速）。如果你不害怕这些行为，那么第 9 章中描述的策略就不会那么重要。
BEHAVIORS THAT CONTRIBUTE TO SOCIAL ANXIETY 导致社交焦虑的行为
All organisms try to avoid situations that cause fear, pain, or discomfort. Avoidance is a method of protecting oneself from possible danger. In the short term, staying away from perceived threats is a very effective way of decreasing or preventing these uncomfortable feelings. Your experience has probably taught you that confronting feared situations causes you to feel overwhelmed and that avoiding or escaping from feared situations leads to a sense of relief. However, avoiding the situations, objects, and feelings that make you anxious is also a guaranteed way to ensure that your fear will continue over the long term. The likelihood of threat in the social situations that you avoid is probably very low. Avoidance can actually do more harm than good, particularly in the long term. 所有生物都会试图避免引起恐惧、疼痛或不适的情境。回避是一种保护自己免受潜在危险的方法。从短期来看，远离被认为有威胁的事物是减少或防止这些不适感的非常有效的方式。你的经历可能已经告诉你，面对恐惧的情境会让你感到不知所措，而回避或逃避恐惧的情境则会带来一种解脱感。然而，回避那些让你焦虑的情境、物体和感受，也是在长期内确保你的恐惧持续存在的保证。你所回避的社交情境中威胁的可能性很低。回避实际上可能弊大于利，尤其是在长期来看。
By avoiding the situations that make you uncomfortable, it may seem as though you prevent your feared negative consequences from occurring. Just as a person who fears flying may believe that avoiding a flight has protected him or her from experiencing a possible plane crash, you may believe that avoiding social or performance situations protects you from experiencing various social catastrophes, such as being humiliated or criticized by others. Of course, statistically, the risk of dying in a plane crash is close to zero (about one in ten million, according to some sources). In other words, the risk of being in a plane crash is almost identical (close to zero) whether you fly or not! The same may be said of public speaking, attending parties, and other social situations. The risk of actual threat or danger is significantly less than socially anxious individuals usually assume. In fact, the long-term consequences of avoiding social situations are often far greater than the risks of confronting these situations. 通过避免让你感到不适的情境，似乎你阻止了自己害怕的负面后果发生。就像害怕飞行的人可能认为避免乘坐飞机保护了他或她免于经历可能的飞机失事一样，你可能认为避免社交或表演场合可以保护你免于经历各种社交灾难，比如被他人羞辱或批评。当然，从统计学上讲，飞机失事致死的风险几乎为零（根据一些资料，大约是千万分之一）。换句话说，无论你是否乘坐飞机，遭遇飞机失事的风险几乎相同（接近于零）！公共演讲、参加聚会以及其他社交场合也可以这样说。实际威胁或危险的风险远低于社交焦虑者通常所认为的。事实上，长期避免社交场合的后果往往远远大于面对这些情境的风险。
Exposure to feared situations and feelings is a very powerful method of learning that avoidance is neither necessary nor helpful in the long run. By confronting your fears, you will discover that many of your anxiety-provoking beliefs and interpretations are untrue or exaggerated. In addition, your interpersonal skills will improve as you will have more opportunities to practice various types of social interaction and performance. In other words, not only will you become more comfortable making small talk, giving speeches, or dealing with conflict situations, you will also become more effective and competent at mastering these challenging situations. 暴露于恐惧的情境和感受是一种非常有效的学习方法，它能让你明白回避从长远来看既不必要也无益。通过面对你的恐惧，你会发现许多引发焦虑的信念和解读是不真实或夸大的。此外，你的人际交往技巧也会得到提升，因为你将有更多机会练习各种类型的社交互动和表现。换句话说，你不仅会在闲聊、演讲或处理冲突情境时变得更加自如，还会在掌控这些挑战性情境方面变得更有效和更有能力。
There are three main types of anxious behaviors that we will review here. Each of these is a potentially harmful habit because it prevents your fear from decreasing over the long term. These behaviors include (1) avoiding feared social and performance situations, (2) avoiding feared sensations and feelings, and (3) subtle avoidance strategies and safety behaviors. 我们将在这里回顾三种主要的焦虑行为类型。每一种行为都是一种潜在的有害习惯，因为它们阻碍了你的恐惧在长期内减少。这些行为包括（1）回避恐惧的社交和表现情境，（2）回避恐惧的感觉和情绪，以及（3）微妙的回避策略和安全行为。
Avoidance of Social Situations 回避社交情境
Avoiding social situations such as public speaking, making conversation, attending meetings, dating, and working out at the gym prevents you from learning that these situations are safe and that your fears are generally unwarranted. Escaping early from these situations (for instance, leaving a party after a few minutes) can also have a negative impact on your fear by reinforcing your experience that being in the situation makes you uncomfortable, and leaving the situation provides relief and a reduction in fear. In reality, staying in a situation despite the fear that it arouses also leads to a reduction in fear. Fear may take longer to decrease when you stay in the situation, but the long-term benefits will be greater. By staying until your fear decreases, you will learn that you can be right in the middle of the situation and feel relatively comfortable. Strategies for overcoming avoidance of feared situations are discussed throughout this chapter, as well as in chapter 8. 避免社交场合，如公开演讲、交谈、参加会议、约会和在健身房锻炼，会阻止你认识到这些场合是安全的，而且你的恐惧通常是没有根据的。过早逃离这些场合（例如，参加聚会几分钟后就离开）也会对你的恐惧产生负面影响，因为这会强化你在这种情况下感到不适，而离开则带来缓解和恐惧减轻的体验。实际上，尽管害怕，留在这种情况下也会导致恐惧的减轻。虽然当你留在现场时，恐惧可能需要更长时间才能减轻，但长期的好处会更大。通过坚持直到恐惧减轻，你会学会即使身处其中，也能感到相对舒适。本章以及第 8 章中将讨论克服对恐惧情境回避的策略。
Avoidance of Feared Sensations 对恐惧感受的回避
As we discussed previously, in addition to avoiding certain situations, you may also avoid feeling certain sensations or feelings, particularly in social situations. Perhaps you avoid eating hot foods that cause you to feel flushed when you’re dining with friends or relatives. Alternatively, you may avoid wearing warm clothes while speaking in public, in case they cause you to sweat. Avoiding sensations such as sweating and blushing reinforces your beliefs that these sensations and feelings are dangerous. If you are fearful of experiencing particular symptoms in the presence of others, you will likely find that exposing yourself to these feelings can help you to become more comfortable with them. The goal is to reach a point at which sensations, like shaking or a racing heartbeat, are, at worst, mildly uncomfortable but not frightening. The general principles discussed throughout this chapter will be relevant to overcoming your fear of physical symptoms. However, specific exercises for overcoming these fears are discussed more thoroughly in chapter 9. 正如我们之前讨论的，除了避免某些情境外，你可能还会避免感受某些感觉或情绪，尤其是在社交场合中。也许你会避免吃那些会让你在与朋友或亲戚共餐时脸红的热食。或者，你可能会避免在公开演讲时穿着厚重的衣服，以免引起出汗。避免像出汗和脸红这样的感觉，会强化你认为这些感觉和情绪是危险的信念。如果你害怕在他人面前出现某些症状，你很可能会发现，暴露自己于这些感觉中可以帮助你变得更加适应它们。目标是达到这样一个程度：像颤抖或心跳加速这样的感觉，最多只是轻微不适，而不是令人恐惧。本章中讨论的一般原则对于克服你对身体症状的恐惧是相关的。然而，克服这些恐惧的具体练习将在第 9 章中更详细地讨论。
Subtle Avoidance Strategies and Safety Behaviors 微妙的回避策略和安全行为
Subtle avoidance behaviors (also called safety behaviors) are not-so-obvious strategies that people often use to cope with anxiety-provoking situations. Unlike completely avoiding a feared situation, subtle avoidance strategies involve partial avoidance of the situation. Often these behaviors are not noticeable to others. In fact, they may be so subtle that even you are not aware of them. As is the case with more obvious types of avoidance, learning to let go of your subtle forms of escape will help you to overcome your fear, just as removing training wheels is an important step in learning to ride a bicycle, and letting go of crutches is an important step in relearning to walk after an injury. We will now discuss some examples of subtle avoidance strategies. 微妙的回避行为（也称为安全行为）是人们常用来应对引发焦虑情境的一些不那么明显的策略。与完全回避恐惧情境不同，微妙的回避策略涉及对情境的部分回避。这些行为通常不易被他人察觉。事实上，它们可能如此微妙，以至于连你自己都未必意识到。正如更明显的回避类型一样，学会放弃这些微妙的逃避方式将帮助你克服恐惧，就像拆掉辅助轮是学骑自行车的重要一步，放下拐杖是受伤后重新学走路的重要一步。接下来，我们将讨论一些微妙回避策略的例子。
Distraction. Distraction involves escaping from anxious thoughts and feelings by focusing on thoughts or images that are more pleasant or by keeping yourself busy with distracting activities. For example, while attending a party, you might offer to help serve food or drinks so that you are constantly busy with some activity and your mind is distracted from the anxious feelings that you might otherwise be experiencing. Or, while traveling on a bus or train, you might always be sure to bring a book or portable radio to distract yourself from feeling anxious about making eye contact with others or from thinking about what others might be thinking about you. Such distractions may help you to feel comfortable while in social or performance situations, but in the long term they prevent you from learning that you can manage the situation without having to rely on subtle avoidance. 分散注意力。分散注意力是通过专注于更愉快的想法或画面，或者通过让自己忙于分散注意力的活动，来逃避焦虑的想法和感受。例如，在参加聚会时，你可能会主动帮忙端菜或倒饮料，这样你就会一直忙于某项活动，心思也就不会被那些可能会让你感到焦虑的情绪所占据。又或者，在乘坐公交车或火车时，你总是会带上一本书或便携式收音机，以此来分散自己对与他人眼神接触感到焦虑，或对别人可能对你有何看法的思考。这些分散注意力的方法可能会帮助你在社交或表演场合中感到舒适，但从长远来看，它们会阻碍你学会在不依赖微妙回避的情况下管理这些情境。
Overprotective behaviors. Overprotective behaviors are small things that you may do to feel safer in the situations that you fear. Examples may include the following: 过度保护行为。过度保护行为是指你为了在害怕的情境中感到更安全而做的一些小动作。例子可能包括以下内容：
Wearing extra makeup or a turtleneck sweater to hide blushing 涂抹更多的化妆品或穿高领毛衣来掩盖脸红
Finding out who else will be at a party before deciding whether to attend 在决定是否参加聚会之前，先了解还有谁会出席
Wearing gloves to hide shaking hands 戴手套来掩盖颤抖的双手
Sitting down or leaning against a podium while giving a presentation 在做演讲时坐下或靠在讲台上
Eating in a dimly lit restaurant so your date won’t notice your anxiety 在灯光昏暗的餐厅用餐，以免约会对象注意到你的焦虑
Wearing sunglasses to help avoid making eye contact 戴太阳镜以帮助避免眼神交流
Always attending social events with a friend so you can avoid talking to people who you don’t know well 总是和朋友一起参加社交活动，以避免与不太熟悉的人交谈
When designing exposure practices, it is important that you also try to eliminate these subtle safety behaviors. 在设计暴露练习时，重要的是你也要尝试消除这些微妙的安全行为。
Overcompensating for perceived deficits. Overcompensating involves working extra hard to make sure that your fearful predictions don’t come true. For example, if you are afraid of looking foolish during a presentation, you may spend days rehearsing and memorizing what you will say. If you’re fearful of making small talk, you may spend hours preparing topics of conversation and rehearsing what you might talk about. If you are afraid of looking unattractive, you may put too much effort into fixing your hair, choosing your clothes, or building your muscles at the gym. In many cases, these situations might be managed with less effort, leaving time and energy for other things. Exposure practices should be designed to eliminate any tendencies to overprepare or overcompensate for flaws that may not even be present. For example, instead of spending hours memorizing a presentation, try giving your talk with only minimal (but still adequate) preparation. 对感知到的缺陷进行过度补偿。过度补偿是指为了确保你害怕的预测不会成真而付出额外努力。例如，如果你害怕在演讲时显得愚蠢，你可能会花几天时间排练和记忆你要说的话。如果你害怕进行闲聊，你可能会花几个小时准备话题并排练可能的对话内容。如果你害怕看起来不吸引人，你可能会花过多精力整理头发、挑选衣服或在健身房锻炼肌肉。在许多情况下，这些情况可以用较少的努力来应对，从而留出时间和精力做其他事情。暴露练习应设计为消除任何过度准备或过度补偿可能根本不存在的缺陷的倾向。例如，不要花几个小时记忆演讲内容，而是尝试只做最少（但仍足够）的准备来进行演讲。
Excessive checking and reassurance seeking. Excessive checking involves spending too much time and effort trying to find out whether you are perceived by others in a positive light. We all engage in occasional checking (for example, looking in the mirror at a party, asking a coworker whether she enjoyed your presentation). In fact, we recommend that you occasionally continue to check on other people’s reactions to you and your actions. Checking and receiving reassurance are helpful ways of testing out your beliefs. However, if you ask for reassurance or check too frequently, this may be a behavior you want to decrease. The key is moderation. Occasional checking is helpful, but constant checking can be a problem. Constantly obtaining reassurance about your performance is like constantly checking with your doctor whenever you experience an unusual sensation. Never going to the doctor may cause you serious health problems that might otherwise have been detected early or prevented. But going to the doctor several times a week to check out every ache and pain can backfire; your doctor may stop taking your concerns and complaints seriously. Constant requests for reassurance can also backfire, having the exact effect that you are trying to avoid-namely a negative response from others. 过度的核查和寻求保证。过度核查指的是花费过多时间和精力试图了解别人是否以积极的眼光看待你。我们都会偶尔进行核查（例如，在聚会上照镜子，问同事她是否喜欢你的演讲）。事实上，我们建议你偶尔继续关注别人对你和你行为的反应。核查和获得保证是检验你信念的有益方式。然而，如果你频繁寻求保证或核查，这可能是你想要减少的行为。关键在于适度。偶尔核查是有帮助的，但不断核查可能成为问题。不断获得关于你表现的保证，就像每当你感到不寻常的感觉时都去找医生检查一样。完全不去看医生可能会导致严重的健康问题，而这些问题本可以早期发现或预防。但每周多次去看医生检查每一个疼痛和不适可能适得其反；你的医生可能会不再认真对待你的担忧和抱怨。 不断请求保证也可能适得其反，产生你试图避免的效果——即他人的负面反应。
Substance use. Substance use can undermine the effects of exposure by artificially lowering your level of fear in social and performance situations. For exposure to be effective, it’s important for you to experience some degree of fear. It is also important for you to learn that your fear will usually decrease naturally if you stay in the situation. Drinking alcohol or using other drugs whenever you are in a situation that makes you anxious will prevent you from learning that your anxiety will decrease even without the drug or alcohol. When designing exposure practices, we recommend that you not drink alcohol or use drugs during the practice. If you want to have a glass of wine or a beer at a party, try to wait until after your fear has decreased somewhat. 物质使用。物质使用可能会削弱暴露疗法的效果，因为它会人为地降低你在社交和表现情境中的恐惧程度。为了使暴露疗法有效，你需要体验到一定程度的恐惧。同时，你还需要学会，如果你坚持待在情境中，恐惧通常会自然减轻。每当你处于让你焦虑的情境时饮酒或使用其他药物，会阻止你学会即使没有药物或酒精，你的焦虑也会减轻。在设计暴露练习时，我们建议你在练习期间不要饮酒或使用药物。如果你想在聚会上喝一杯葡萄酒或啤酒，尽量等到你的恐惧有所减轻之后再喝。
A STEP-BY-STEP OVERVIEW FOR CONDUCTING EXPOSURE-BASED TREATMENTS 基于暴露的治疗步骤概览
The main steps involved in any exposure-based treatment program are initial assessment, planning appropriate practices, carrying out the practices, and taking steps to maintain the improvements over the long term. 任何基于暴露的治疗项目的主要步骤包括初步评估、规划合适的练习、执行练习，以及采取措施维持长期的改善效果。
Initial Assessment 初步评估
We discussed the issue of assessment in chapter 3. To plan effective exposure practices, you will need to know the situations and sensations that you fear and avoid as well as becoming aware of the different variables that affect your fear level. When you completed the exercises in chapter 3, you probably identified a number of variables that affect your fear level when you are in a social or performance situation that causes you to feel uncomfortable. You should review the relevant sections of chapter 3 before beginning your exposure practices. 我们在第 3 章讨论了评估的问题。为了规划有效的暴露练习，你需要了解自己害怕和回避的情境及感受，同时意识到影响你恐惧程度的不同变量。当你完成第 3 章的练习时，你可能已经确定了一些在社交或表演情境中让你感到不适时影响你恐惧程度的变量。你应在开始暴露练习前复习第 3 章的相关部分。
Planning Appropriate Practices 规划合适的练习
Planning your exposure practices starts with developing an exposure bierarchy. An exposure hierarchy is a list of feared situations ranked in order of difficulty, from least fear provoking at the bottom, to most fear provoking at the top. Chapter 8 provides examples of hierarchies and includes instructions on how to develop your own hierarchy for situational exposure. Chapter 9 provides sample hierarchies and instructions for developing a hierarchy for exposure to feared sensations. Developing an exposure hierarchy will provide a structure that will allow you to begin with easier exercises and work your way up to more difficult ones. 规划你的暴露练习从制定暴露层级开始。暴露层级是一份害怕情境的列表，按难度顺序排列，最不引起恐惧的情境排在底部，最引起恐惧的情境排在顶部。第 8 章提供了层级的示例，并包含如何为情境暴露制定你自己的层级的指导。第 9 章提供了示例层级以及制定针对害怕感受的暴露层级的指导。制定暴露层级将提供一个结构，使你能够从较简单的练习开始，逐步挑战更困难的练习。
Carrying Out the Practices 执行练习
Once you’ve identified some practices likely to be helpful, the next step is to begin carrying them out. Generally, exposure begins with more manageable situations and works up to more and more difficult situations. As confronting the situations becomes easier, you should begin to let go of the subtle forms of avoidance that were discussed earlier. Later, after practicing situational exposure for several weeks (as described in chapter 8), it may be useful to add exercises involving exposure to feared feelings and sensations (as described in chapter 9). 一旦你确定了一些可能有帮助的练习，下一步就是开始实施它们。通常，暴露练习从较易应对的情境开始，逐步过渡到越来越困难的情境。随着面对这些情境变得更加容易，你应该开始放弃之前讨论过的那些微妙的回避方式。之后，在练习情境暴露数周（如第 8 章所述）后，加入涉及暴露于恐惧的感受和感觉的练习（如第 9 章所述）可能会很有帮助。
Exposure practices should be structured, planned in advance, and carried out frequently. The ways in which exposure practices are carried out affect whether the practices are helpful or not. Exposure can actually increase your fear if not done properly. The remaining sections of this chapter provide suggestions for the best ways to conduct exposure to maximize the chances of decreasing your fear. 暴露练习应当有结构、有计划地提前安排，并且频繁进行。暴露练习的实施方式会影响练习是否有效。如果方法不当，暴露实际上可能会增加你的恐惧。本章剩余部分将提供进行暴露的最佳方法建议，以最大限度地降低你的恐惧。
Maintaining Your Improvements 保持你的进步
In order to maintain your improvements, it’s important that you continue occasional practices even after your fear has decreased. These strategies are explored in greater detail in chapter 11. 为了保持你的进步，即使恐惧已经减轻，继续偶尔进行练习也很重要。这些策略将在第 11 章中进行更详细的探讨。
TYPES OF EXPOSURE 暴露类型
This section discusses three different dimensions that should be taken into account when planning exposure practices. They are (1) exposure to social situations vs. feared sensations; (2) imagined vs. live exposure; and (3) gradual vs. rapid exposure. 本节讨论在规划暴露练习时应考虑的三个不同维度。它们是（1）暴露于社交情境与害怕的感觉；（2）想象暴露与现场暴露；以及（3）渐进式暴露与快速暴露。
Exposure to Social Situations vs. Feared Sensations 暴露于社交情境与害怕的感觉
Situational exposure involves exposing oneself to places and situations that produce anxiety. Overcoming social and performance anxiety almost always includes situational exposure as a component. In other words, to become more comfortable with public speaking, meeting strangers, or lunching with your coworkers, you will need to practice these activities. 情境暴露指的是让自己接触那些引发焦虑的地点和情境。克服社交和表现焦虑几乎总是包含情境暴露这一环节。换句话说，要想在公开演讲、与陌生人见面或与同事共进午餐时感到更自在，你需要练习这些活动。
Some people with social and performance anxiety may also benefit from exposure to sensations. This form of exposure is sometimes called interoceptive exposure, and it involves practicing exercises that trigger particular physical sensations. For example, spinning in a chair can be used to induce dizziness, and running up and down the stairs will make your heart race. Exposure to sensations is useful for people who are fearful of experiencing uncomfortable physical feelings. 一些有社交和表演焦虑的人也可能从感官暴露中受益。这种形式的暴露有时被称为内感受暴露，涉及练习引发特定身体感觉的练习。例如，坐在椅子上旋转可以引起头晕，跑上跑下楼梯会让你的心跳加速。感官暴露对害怕经历不适身体感觉的人来说很有用。
If you are not afraid of the physical sensations that you experience when anxious, there is no need to practice these exercises. However, if you are frightened by the physical sensations you experience in social situations, you may find it helpful to practice experiencing these feelings purposely until they no longer frighten you. Exposure to sensations can be combined with situational exposure so that feared physical feelings are purposefully brought on during the course of the exposure to feared situations. Chapter 9 provides a detailed description of how to use interoceptive exposure to reduce your fear of sensations. 如果你不害怕在焦虑时体验到的身体感觉，就没有必要练习这些练习。然而，如果你害怕在社交场合中体验到的身体感觉，你可能会发现有意识地练习体验这些感觉直到它们不再让你害怕是有帮助的。感官暴露可以与情境暴露结合使用，使害怕的身体感觉在暴露于害怕的情境过程中被有意识地引发。第 9 章详细介绍了如何使用内感受暴露来减少你对感觉的恐惧。
Imagined vs. Live Exposure 想象暴露与现场暴露
Exposure can be conducted in your imagination (imagining being in a feared situation) or in real life (actually entering the feared situation). Generally, whenever possible, we recommend that live exposure (also called in vivo exposure) be used rather than imagined exposure. Although both approaches can lead to a reduction of fear, live exposure has two big advantages. First, some people have difficulty imagining feared situations in a way that actually arouses their fear; and, second, there is evidence that live exposure is more effective at reducing fear (Emmelkamp and Wessels 1975). 暴露可以在你的想象中进行（想象自己处于害怕的情境中），也可以在现实生活中进行（实际进入害怕的情境）。一般来说，只要可能，我们建议使用现实暴露（也称为体感暴露），而不是想象暴露。虽然这两种方法都能减少恐惧，但现实暴露有两个显著优势。首先，有些人难以通过想象害怕的情境来真正激发他们的恐惧；其次，有证据表明现实暴露在减少恐惧方面更为有效（Emmelkamp 和 Wessels 1975）。
Nevertheless, under certain circumstances, imagined exposure may be helpful. If you are too fearful to enter a situation in real life, you can use imagined exposure as a stepping-stone to the real situation. For example, if you are planning to ask someone out on a date, you might consider using an imagined exposure to the situation at first. Once you have become more comfortable imagining the situation, trying the real thing might become easier. Also, imagined exposure can be helpful when the situation is impractical or impossible to practice in real life. For example, if you must give a presentation to a group of 200 people, you may not be able to practice it in front of a large group. Instead, imagining a large group in your mind’s eye might be a good way to practice for the actual presentation when you are preparing your talk. 尽管如此，在某些情况下，想象暴露可能是有帮助的。如果你害怕到无法在现实生活中进入某个情境，你可以将想象暴露作为通向真实情境的垫脚石。例如，如果你打算邀请某人约会，你可以先考虑使用想象暴露来面对这种情境。一旦你对想象这种情境感到更加自在，尝试真实情境可能会变得更容易。此外，当某个情境在现实生活中不切实际或不可能练习时，想象暴露也能发挥作用。例如，如果你必须向 200 人群体做演讲，你可能无法在大群体面前练习。相反，在脑海中想象一个大群体，可能是准备演讲时练习的好方法。
Situational role-play is a compromise between imagined exposure and live exposure. Role-play involves rehearsing being in a particular situation with the help of a friend, family member, or therapist. For example, before exposing yourself to a real job interview, you could practice mock interviews with other individuals posing as the interviewers. Or, you could ask your family or friends to act as the audience while you practice a presentation. These various forms of situational exposure (imagined, in vivo, and role-plays) are discussed more thoroughly in chapter 8. 情境角色扮演是想象暴露和现场暴露之间的一种折中方式。角色扮演是在朋友、家人或治疗师的帮助下，排练处于特定情境中的表现。例如，在真正参加工作面试之前，你可以与其他人进行模拟面试，让他们扮演面试官。或者，你可以请家人或朋友作为观众，帮助你练习演讲。这些不同形式的情境暴露（想象暴露、现场暴露和角色扮演）将在第 8 章中更详细地讨论。
Gradual vs. Rapid Exposure 渐进式暴露与快速暴露
Exposure may be conducted gradually or rapidly. Rapid exposure involves taking steps very quickly, skipping steps, and sometimes trying more difficult situations before you have completely mastered easier situations. For example, rapid exposure to public speaking might have you start off with talking in front of large groups of unfamiliar people instead of to small groups of familiar people. 暴露可以逐步进行，也可以快速进行。快速暴露是指采取非常快的步骤，跳过某些步骤，有时在完全掌握较简单情境之前就尝试更困难的情境。例如，快速暴露于公众演讲可能会让你一开始就在陌生人的大群体面前讲话，而不是在熟悉的小群体面前讲话。
Gradual exposure tends to begin with easier practices and progresses to the more difficult practices much more slowly. Compared with rapid exposure, a person who is working on gradual exposure may spend more time practicing each step before moving on to the next level of difficulty. In addition, gradual exposure is less likely to leave out intermediate steps, compared with rapid exposure. With gradual exposure, by the time you get to the top steps of your hierarchy, you will be better prepared and less likely to feel overwhelmed by the practice. 渐进式暴露通常从较简单的练习开始，进展到较困难的练习则要慢得多。与快速暴露相比，进行渐进式暴露的人可能会在进入下一个难度级别之前花更多时间练习每一个步骤。此外，与快速暴露相比，渐进式暴露不太可能跳过中间步骤。通过渐进式暴露，当你达到层级结构的最高步骤时，你会更有准备，也不太可能因练习而感到不知所措。
Gradual exposure is similar to progressing through school one grade at a time. If you had to jump from ninth grade to twelfth grade, you would likely find the increase in difficulty overwhelming. By progressing through high school one grade at a time, you find each grade to be just slightly more difficult than the previous grade. By the time you get to twelfth grade, the increase in difficulty is only a small step compared with your work in eleventh grade. 渐进式暴露类似于逐年升学。如果你必须从九年级直接跳到十二年级，你很可能会觉得难度的增加令人难以承受。通过逐年升入高中，你会发现每个年级的难度都只比前一个年级稍微高一点。当你升到十二年级时，难度的增加相比于你在十一年级的学习只是一个小的进步。
Gradual exposure to public speaking might begin by presenting small speeches in front of a close friend or family member or by asking questions at meetings. After those practice situations become easier, you might try speaking for longer periods of time during meetings or practicing a speech in front of a small group of friends or family members. This could then progress to practicing your speech in front of several coworkers. With gradual exposure, you might not actually speak in front of large groups of unfamiliar people until many earlier steps have been mastered. 逐步暴露于公众演讲的过程可能从在亲密的朋友或家人面前发表简短演讲或在会议上提问开始。当这些练习情境变得更容易后，你可以尝试在会议中讲话时间更长，或在一小群朋友或家人面前练习演讲。接着，可以逐步过渡到在几位同事面前练习演讲。通过逐步暴露，直到掌握了许多早期步骤后，你才可能真正面对陌生的大群体进行演讲。
Gradual and rapid exposure are both effective ways of reducing fear, and the end result of each is usually the same. However, each approach has advantages and disadvantages over the other. With rapid exposure it is likely you will see changes more quickly, which will save you time. Also, these quick results may motivate you to work even harder at overcoming your fear, just as seeing quick changes in your weight or fitness level can motivate you to stick to an exercise and healthy-eating plan. However, compared with gradual exposure, rapid exposure is associated with higher levels of discomfort and fear. 逐步暴露和快速暴露都是有效减少恐惧的方法，且最终结果通常相同。然而，每种方法各有优缺点。快速暴露可能让你更快看到变化，从而节省时间。此外，这些快速的结果可能激励你更加努力克服恐惧，就像看到体重或体能水平的快速变化能激励你坚持锻炼和健康饮食计划一样。然而，与逐步暴露相比，快速暴露通常伴随着更高程度的不适和恐惧。
Rapid exposure requires a strong commitment from you to tolerate higher levels of discomfort. 快速暴露需要你有强烈的承受更高程度不适的决心。
The differences between these two forms of exposure can be compared to the difference between jumping into a cold swimming pool and entering the pool slowly. Jumping into the pool quickly causes more initial discomfort, but you get used to the water more quickly. On the other hand, getting into the pool slowly and gradually may be less shocking to your system, but it will take you longer to get used to the water. 这两种暴露形式的区别可以比作跳入冰冷的游泳池和慢慢进入游泳池的区别。快速跳入游泳池会带来更多的初始不适，但你会更快适应水温。另一方面，慢慢逐渐进入游泳池对你的身体冲击较小，但你需要更长时间来适应水温。
We recommend that you practice exposures as quickly as you are willing to. If you are able to take steps more quickly, you will overcome your anxiety more quickly. If you prefer a more gradual approach, that’s fine, too. Sometimes, you may find it difficult to judge whether a particular step is too difficult. Remember, there is no harm in taking steps too quickly. If an exercise ends up becoming too overwhelming, you have the option of continuing to practice it until it becomes easier or stepping back, trying a less difficult exercise, and working your way up to the difficult practice more gradually. Either approach is likely to be helpful. The decision is a matter of personal preference and how much discomfort you’re willing to tolerate. 我们建议你尽可能快地进行暴露练习。如果你能够更快地采取步骤，你将更快地克服焦虑。如果你更喜欢渐进的方法，也完全没问题。有时，你可能难以判断某个步骤是否过于困难。请记住，采取步骤过快并不会有害。如果某个练习变得过于压倒性，你可以选择继续练习，直到它变得更容易，或者退一步，尝试一个难度较低的练习，然后逐渐过渡到较难的练习。无论哪种方法，都可能有帮助。这个决定取决于个人偏好以及你愿意忍受多少不适。
HOW EXPOSURE WORKS 暴露疗法的原理
Many cognitive-behavioral researchers and therapists believe that exposure works by providing individuals with an opportunity to test the validity of their fearful thoughts, assumptions, and interpretations. In chapter 6, we discussed the use of behavioral experiments for challenging anxious beliefs and predictions. Repeated exposure may be thought of as a form of behavioral experiment. By entering feared situations and exposing yourself to feared sensations repeatedly, you will discover whether your beliefs about social and performance situations are true or false. 许多认知行为研究者和治疗师认为，暴露疗法的作用在于为个体提供一个机会，去验证他们恐惧的想法、假设和解读的真实性。在第 6 章中，我们讨论了使用行为实验来挑战焦虑的信念和预测。反复的暴露可以被视为一种行为实验。通过进入恐惧的情境并反复暴露于恐惧的感觉中，你将发现自己对社交和表现情境的信念是真还是假。
Why Exposure May Not Have Worked in the Past 为什么暴露疗法过去可能没有效果
People who are about to begin exposure-based treatments often wonder why they should expect exposure to work now if it hasn’t worked in the past. In all likelihood, you’ve already been exposed to anxiety-provoking social situations from time to time and, in many cases, your fear has probably not decreased. In fact, your anxiety may have increased with repeated exposures. Given such previous experiences with exposure, you may be skeptical about whether simply exposing yourself again to feared social situations will lead to a decrease in your fear. 即将开始基于暴露的治疗的人们常常会想，如果过去暴露疗法没有效果，为什么现在应该期望它有效。很可能，你已经时不时地暴露于引发焦虑的社交情境中，在许多情况下，你的恐惧可能并没有减少。事实上，随着反复暴露，你的焦虑可能还增加了。鉴于过去对暴露的这些经历，你可能会怀疑仅仅再次暴露于恐惧的社交情境是否会导致恐惧的减轻。
It’s important to acknowledge that exposure is not effective under all circumstances. For example, unpredictable exposure can lead to an increase in fear, particularly if it involves a negative event or consequence. Imagine this situation: You are afraid of dogs and a dog unexpectedly runs out from behind a tree and starts growling at you. That kind of exposure would only make your fear worse. On the other hand, if you are 重要的是要承认，暴露疗法并非在所有情况下都有效。例如，不可预测的暴露可能会导致恐惧增加，尤其是当它涉及负面事件或后果时。想象这样一种情况：你害怕狗，一只狗突然从树后跑出来，对你咆哮。那种暴露只会让你的恐惧加重。另一方面，如果你
gradually exposed to your neighbor’s friendly dog, at your own pace, your fear of dogs might decrease. 逐渐以自己的节奏接触邻居友善的狗，你对狗的恐惧可能会减少。
In everyday life, exposure to feared situations is often unpredictable. In addition, such everyday exposures tend to be brief and infrequent. All of these factors make exposure in everyday life less likely to lead to a decrease in fear, compared with the type of exposure that is used in cognitive-behavioral therapy. A summary of the main differences between the type of exposure you may have experienced in the past (previous exposure) and the type that has been shown as useful for helping people overcome fear (therapeutic exposure) appears below. 在日常生活中，接触恐惧情境往往是不可预测的。此外，这种日常暴露通常是短暂且不频繁的。所有这些因素使得日常生活中的暴露相比认知行为疗法中使用的暴露，更不可能导致恐惧的减轻。下面总结了你过去可能经历过的暴露类型（以往暴露）与已被证明有助于人们克服恐惧的暴露类型（治疗性暴露）之间的主要区别。
Typical Previous Exposures 典型的以往暴露
These are often unpredictable and uncontrollable (e.g., you “end up” in the middle of an unexpected conversation; you are “forced” to go to a party that you would rather not attend). 这些情况通常是不可预测且无法控制的（例如，你“最终”陷入一场意外的对话；你被“迫使”去参加一个你本不想去的聚会）。
These have a brief duration (e.g., you get into the situation, feel anxious, then leave. This teaches you that when you are in the situation you feel frightened, but when you leave you feel better). 这些情况持续时间很短（例如，你进入情境，感到焦虑，然后离开。这教会你，当你处于这种情境时会感到害怕，但离开后你会感觉好些）。
These are infrequent (e.g., because you usually avoid when anxious, you are not in the feared situation very often. Each time you are in the situation, it’s like starting over). 这些情况发生频率很低（例如，因为你通常在焦虑时会回避，所以你很少处于害怕的情境中。每次处于这种情境时，就像重新开始一样）。
These usually involve anxious thinking (e.g., “People think I’m an idiot,” “People will think I’m incompetent if they notice my shaky hands”). 这些情况通常伴随着焦虑的思维（例如，“别人会认为我很笨”，“如果他们注意到我颤抖的手，别人会认为我无能”）。
These include subtle ways of avoiding the situation (e.g., by distracting yourself, using alcohol, bringing someone with you, sitting in a certain “safe” location). 这些包括避免情境的微妙方式（例如，通过分散注意力、饮酒、带上某人、坐在某个“安全”位置）。
Typical Therapeutic Exposures 典型的治疗性暴露
These are predictable and under your control (e.g., you make a decision to enter an anxiety-provoking situation specifically so that you can learn to be more comfortable in the situation). 这些是可预测且在你控制之下的（例如，你决定进入一个引发焦虑的情境，目的是为了学习在该情境中变得更加舒适）。
These are prolonged (e.g., you decide to stay in a situation until the anxiety comes down on its own or until you learn that your feared consequence doesn’t occur. Here, you learn that you can be in the situation, nothing bad happens, and your anxiety eventually subsides). 这些是持续时间较长的（例如，你决定留在某个情境中，直到焦虑自然减退或直到你了解到你所害怕的后果并未发生。在这里，你学会了你可以处于该情境中，没有坏事发生，且你的焦虑最终会消退）。
These are frequent (e.g., you practice your exposures over and over again and close together. The benefits of exposures start to add up). 这些是频繁的（例如，你反复且密集地练习暴露。暴露的益处开始累积）。
These include countering of your anxious thoughts (e.g., you ask yourself questions to counter or challenge the anxious beliefs and predictions). 这些包括反驳你的焦虑想法（例如，你通过提问来反驳或挑战焦虑的信念和预测）。
These do not include subtle avoidance strategies (e.g., you make a decision to not use these strategies so that you teach yourself to master the situation on your own). 这些不包括微妙的回避策略（例如，你决定不使用这些策略，以便教自己独立掌控情境）。
Adapted from Antony, M. M. and R. P. Swinson. 2000. Phobic Disorders and Panic in Adults: A Guide to Assessment and Treatment. Washington, DC: American Psychological Association. Used with permission. 改编自 Antony, M. M. 和 R. P. Swinson. 2000. 《成人恐惧症和惊恐障碍：评估与治疗指南》。华盛顿特区：美国心理学会。经许可使用。
OBSTACLES TO COMPLETING EXPOSURE PRACTICES 完成暴露练习的障碍
There are many different reasons why people sometimes don’t follow through on exposure practices. We suggest that you anticipate the possible obstacles in advance and try to think of ways to overcome them. There are always going to be reasons not to practice. To combat the excuses you will undoubtedly come up with, you will need to remind yourself of your reasons to continue to practice despite lack of desire, lack of time, or being overwhelmed with the idea of confronting situations that make you anxious and uncomfortable. Here is a listing of some of the most common reasons why people procrastinate when it comes to doing exposure exercises. We’ve also offered some possible solutions to these problems. 人们有许多不同的原因导致有时无法坚持完成暴露练习。我们建议你提前预见可能遇到的障碍，并尝试想出克服它们的方法。总会有不想练习的理由。为了对抗你无疑会想出的借口，你需要提醒自己继续练习的理由，尽管你可能缺乏动力、时间不足，或者面对让你感到焦虑和不适的情境时感到不知所措。以下列出了一些人们在进行暴露练习时最常拖延的原因。我们也提供了一些可能的解决方案。
Obstacle: 障碍：
My practices are never planned in enough detail, so I am not sure exactly what I am supposed to do. 我的练习从未被详细规划过，所以我不确定自己到底应该做什么。
Solution: 解决方案：
At the beginning of each week, plan your exposure practices thoroughly. You should know exactly what you're going to do, where you're going to do it, and when you're going to practice (dates and times). 在每周开始时，彻底规划你的暴露练习。你应该确切知道自己将做什么、在哪里做以及何时练习（具体日期和时间）。
Obstacle: 障碍：
Although I have good intentions, my plans never seem to work out. For example, when I plan to have lunch with a friend, I often find that my friend isn't available when I call. 尽管我有良好的意图，但我的计划似乎总是无法实现。例如，当我计划与朋友共进午餐时，打电话时常发现朋友没空。
Solutions: 解决方案：
Make sure you make plans early. Leaving things for the last minute will make it much more likely that your plans won't work out. 确保你提前制定计划。把事情留到最后一刻会大大增加计划无法实现的可能性。
Be sure to have a backup plan. For example, if you're planning to have lunch with a coworker, make sure you have an alternative second plan and, sometimes, even a third plan, just in case your friend isn't available for lunch. 一定要有备选方案。例如，如果你计划和同事共进午餐，确保你有第二个备选方案，有时甚至要有第三个方案，以防你的朋友无法一起吃午饭。
Obstacle: 障碍：
I always forget to practice. 我总是忘记练习。
Solutions: 解决方案：
Plan your practices the way you would any other activity in your day. Set aside blocks of time to practice and record them in your appointment calendar just as you would for any other appointments, so you don't forget. 像安排一天中的其他活动一样安排练习时间。预留时间段进行练习，并将其记录在你的日程表中，就像安排其他约会一样，这样你就不会忘记。
Set an alarm (e.g., on your wristwatch or a small clock) as a reminder to practice. 设置一个闹钟（例如手表或小闹钟）作为练习提醒。
Ask other people to remind you, if necessary. 如果有必要，可以请其他人提醒你。
Obstacle: 障碍：
The idea of doing therapeutic exposure work seems overwhelming. I am just too scared. 进行治疗性暴露练习的想法让人感到不知所措。我实在太害怕了。
Obstacle: My practices are never planned in enough detail, so I am not sure exactly what I am supposed to do.
Solution: At the beginning of each week, plan your exposure practices thoroughly. You should know exactly what you're going to do, where you're going to do it, and when you're going to practice (dates and times).
Obstacle: Although I have good intentions, my plans never seem to work out. For example, when I plan to have lunch with a friend, I often find that my friend isn't available when I call.
Solutions: Make sure you make plans early. Leaving things for the last minute will make it much more likely that your plans won't work out.
Be sure to have a backup plan. For example, if you're planning to have lunch with a coworker, make sure you have an alternative second plan and, sometimes, even a third plan, just in case your friend isn't available for lunch.
Obstacle: I always forget to practice.
Solutions: Plan your practices the way you would any other activity in your day. Set aside blocks of time to practice and record them in your appointment calendar just as you would for any other appointments, so you don't forget.
Set an alarm (e.g., on your wristwatch or a small clock) as a reminder to practice.
Ask other people to remind you, if necessary.
Obstacle: The idea of doing therapeutic exposure work seems overwhelming. I am just too scared.| Obstacle: | My practices are never planned in enough detail, so I am not sure exactly what I am supposed to do. |
| :--- | :--- |
| Solution: | At the beginning of each week, plan your exposure practices thoroughly. You should know exactly what you're going to do, where you're going to do it, and when you're going to practice (dates and times). |
| Obstacle: | Although I have good intentions, my plans never seem to work out. For example, when I plan to have lunch with a friend, I often find that my friend isn't available when I call. |
| Solutions: | Make sure you make plans early. Leaving things for the last minute will make it much more likely that your plans won't work out. |
| | Be sure to have a backup plan. For example, if you're planning to have lunch with a coworker, make sure you have an alternative second plan and, sometimes, even a third plan, just in case your friend isn't available for lunch. |
| Obstacle: | I always forget to practice. |
| Solutions: | Plan your practices the way you would any other activity in your day. Set aside blocks of time to practice and record them in your appointment calendar just as you would for any other appointments, so you don't forget. |
| | Set an alarm (e.g., on your wristwatch or a small clock) as a reminder to practice. |
| | Ask other people to remind you, if necessary. |
| Obstacle: | The idea of doing therapeutic exposure work seems overwhelming. I am just too scared. |
Solutions: 解决方案：
Start with an easier practice. The activity that you choose should be challenging but not completely overwhelming. If a particular task seems impossible, start with an easier task that does seem possible. 从一个较简单的练习开始。你选择的活动应该具有挑战性，但不要让人感到完全无法承受。如果某个任务看起来不可能完成，就从一个看起来可能完成的较简单任务开始。
Use the cognitive strategies discussed in chapter 6 to challenge your anxious thoughts before entering a feared situation. 在进入令你害怕的情境之前，使用第 6 章中讨论的认知策略来挑战你的焦虑想法。
Obstacle: 障碍：
I'm too busy. There never seems to be enough time to do the work. 我太忙了。似乎永远没有足够的时间去完成工作。
Solutions: 解决方案：
Put aside small blocks of time to be used exclusively for your social anxiety exposure practices. If time is reserved just for this purpose, you will be less likely to feel as if your practices are getting in the way of your other important activities. This is something you want to do for yourself. If you really want to deal with your social anxiety, you know you can find the small blocks of time to reserve for the practices. Think of practice times as taking a class. You may not always want to go to a class, but if you want to learn what is being taught there, you find the time to go. 留出小块时间专门用于进行社交焦虑暴露练习。如果专门为此预留时间，你就不太可能觉得练习妨碍了其他重要活动。这是你为自己做的事情。如果你真的想应对社交焦虑，你知道自己可以找到小块时间来进行练习。把练习时间当作上课。你可能并不总想去上课，但如果你想学到课堂上教的内容，你就会找到时间去。
Choose practices that can be completed during the course of your regular routine. For example, you need to eat every day-you might as well eat some of your meals with other people instead of always eating alone. 选择可以在日常生活中完成的练习。例如，你每天都需要吃饭——你不妨尝试和别人一起吃饭，而不是总是独自用餐。
Set aside a large block of time (e.g., clear a week-long vacation from work) and spend the whole time practicing exposure nonstop. 留出一大块时间（例如，清出一周的假期），全程不停地进行暴露练习。
Obstacle: 障碍：
I am not convinced that exposure practices will be helpful. 我不相信暴露练习会有帮助。
Solutions: 解决方案：
Begin with a smaller exposure practice in which you have little to lose, but in which you can still test whether exposing yourself to the situation leads to a decrease in your fear. 从一个较小的暴露练习开始，在这种情况下你几乎没有什么可失去的，但你仍然可以测试暴露自己于该情境是否会导致恐惧感的减轻。
The belief that exposure won't work is probably just an example of a negative thought that isn't necessarily true. Examine the validity of your beliefs regarding exposure. For example, can you think of reasons why exposure may not have worked in the past? After you finish reading this chapter, you may have some new ideas about how to ensure that exposure will be more likely to work now. 认为暴露疗法无效的想法很可能只是一个不一定真实的消极想法。请审视你关于暴露疗法的信念的有效性。例如，你能否想出过去暴露疗法可能无效的原因？在你读完本章后，你可能会有一些新的想法，帮助你确保暴露疗法现在更有可能奏效。
Obstacle: 障碍：
My feared situations are difficult to create. For example, I can't think of any places to practice public speaking. 我害怕的情境很难创造。例如，我想不到任何可以练习公开演讲的场所。
Solutions: 解决方案：
Chapter 8 contains a large number of possible situations in which to practice exposure. Reading chapter 8 should help you to generate ideas. 第 8 章包含了大量可供练习暴露的可能情境。阅读第 8 章应能帮助你产生一些想法。
Talk to family members and friends. They may be able to help you to come up with some ideas for practices. 与家人和朋友交谈。他们可能能够帮助你想出一些练习的点子。
Solutions: Start with an easier practice. The activity that you choose should be challenging but not completely overwhelming. If a particular task seems impossible, start with an easier task that does seem possible.
Use the cognitive strategies discussed in chapter 6 to challenge your anxious thoughts before entering a feared situation.
Obstacle: I'm too busy. There never seems to be enough time to do the work.
Solutions: Put aside small blocks of time to be used exclusively for your social anxiety exposure practices. If time is reserved just for this purpose, you will be less likely to feel as if your practices are getting in the way of your other important activities. This is something you want to do for yourself. If you really want to deal with your social anxiety, you know you can find the small blocks of time to reserve for the practices. Think of practice times as taking a class. You may not always want to go to a class, but if you want to learn what is being taught there, you find the time to go.
Choose practices that can be completed during the course of your regular routine. For example, you need to eat every day-you might as well eat some of your meals with other people instead of always eating alone.
Set aside a large block of time (e.g., clear a week-long vacation from work) and spend the whole time practicing exposure nonstop.
Obstacle: I am not convinced that exposure practices will be helpful.
Solutions: Begin with a smaller exposure practice in which you have little to lose, but in which you can still test whether exposing yourself to the situation leads to a decrease in your fear.
The belief that exposure won't work is probably just an example of a negative thought that isn't necessarily true. Examine the validity of your beliefs regarding exposure. For example, can you think of reasons why exposure may not have worked in the past? After you finish reading this chapter, you may have some new ideas about how to ensure that exposure will be more likely to work now.
Obstacle: My feared situations are difficult to create. For example, I can't think of any places to practice public speaking.
Solutions: Chapter 8 contains a large number of possible situations in which to practice exposure. Reading chapter 8 should help you to generate ideas.
Talk to family members and friends. They may be able to help you to come up with some ideas for practices.| Solutions: | Start with an easier practice. The activity that you choose should be challenging but not completely overwhelming. If a particular task seems impossible, start with an easier task that does seem possible. |
| :--- | :--- |
| | Use the cognitive strategies discussed in chapter 6 to challenge your anxious thoughts before entering a feared situation. |
| Obstacle: | I'm too busy. There never seems to be enough time to do the work. |
| Solutions: | Put aside small blocks of time to be used exclusively for your social anxiety exposure practices. If time is reserved just for this purpose, you will be less likely to feel as if your practices are getting in the way of your other important activities. This is something you want to do for yourself. If you really want to deal with your social anxiety, you know you can find the small blocks of time to reserve for the practices. Think of practice times as taking a class. You may not always want to go to a class, but if you want to learn what is being taught there, you find the time to go. |
| | Choose practices that can be completed during the course of your regular routine. For example, you need to eat every day-you might as well eat some of your meals with other people instead of always eating alone. |
| | Set aside a large block of time (e.g., clear a week-long vacation from work) and spend the whole time practicing exposure nonstop. |
| Obstacle: | I am not convinced that exposure practices will be helpful. |
| Solutions: | Begin with a smaller exposure practice in which you have little to lose, but in which you can still test whether exposing yourself to the situation leads to a decrease in your fear. |
| | The belief that exposure won't work is probably just an example of a negative thought that isn't necessarily true. Examine the validity of your beliefs regarding exposure. For example, can you think of reasons why exposure may not have worked in the past? After you finish reading this chapter, you may have some new ideas about how to ensure that exposure will be more likely to work now. |
| Obstacle: | My feared situations are difficult to create. For example, I can't think of any places to practice public speaking. |
| Solutions: | Chapter 8 contains a large number of possible situations in which to practice exposure. Reading chapter 8 should help you to generate ideas. |
| | Talk to family members and friends. They may be able to help you to come up with some ideas for practices. |
HOW TO CONDUCT EXPOSURE PRACTICES 如何进行暴露练习
This section provides suggestions for getting the most out of your exposure practices. These include instructions for how to prepare for practices, suggestions to keep in mind when planning practices, what to do during a particular practice, and what to do following the practice. Some of the most important suggestions are summarized in a checklist following this section. 本节提供了如何最大限度利用暴露练习的建议。这些建议包括如何为练习做准备、在计划练习时应记住的事项、在具体练习中应做的事情以及练习结束后应做的事情。本节后面附有一份总结了最重要建议的清单。
Preparing for Exposure Practices 准备暴露练习
As much as possible, it’s important to plan your exposure practices in advance. As discussed earlier, planning involves making decisions at the beginning of the week about particular practices that you intend to try, as well as coming up with backup practices in case your original plans don’t work out. It is very likely that planning will involve setting aside specific times during which to practice. You should also have an idea of how a practice fits in with your short-term and long-term goals. For example, if your long-term goal is to be able to give a presentation to a large group of coworkers, practicing speaking to smaller groups may be an important step in your plan. 尽可能提前规划你的暴露练习非常重要。如前所述，规划包括在一周开始时决定你打算尝试的具体练习，以及制定备用练习以防原计划未能实现。规划很可能需要你预留特定时间进行练习。你还应当了解某项练习如何与你的短期和长期目标相契合。例如，如果你的长期目标是能够向一大群同事做演讲，那么练习向较小的群体讲话可能是你计划中的重要一步。
Before beginning any particular practice, we suggest that you make some very specific predictions about what might happen during the practice. Once you are aware of your anxiety-provoking thoughts and predictions, use the cognitive strategies described in chapter 6 to challenge your thoughts. Challenging your anxious thoughts before entering into the situation will help you to manage your fear and discomfort. 在开始任何特定练习之前，我们建议你对练习过程中可能发生的情况做出非常具体的预测。一旦你意识到引发焦虑的想法和预测，使用第 6 章中描述的认知策略来挑战你的想法。在进入情境之前挑战你的焦虑想法，将帮助你管理恐惧和不适。
Importance of Predictability and Control 可预测性和控制的重要性
As we discussed earlier, exposure works better if it is predictable and if you have a sense of control over what’s happening in the situation. Therefore, it’s best to start with exposure practices in which you have a pretty good idea of what is likely to happen. Some situations, however, are inherently unpredictable. For example, if you decide to ask another person out on a date, it may be impossible to know how the other person will respond. In these cases, you can make the situation somewhat more predictable by considering in advance all of the possible outcomes that could occur. For example, the person might accept your invitation, turn it down, or put off responding for the time being (for example, by not returning your call or saying, “I’m not sure, let me get back to you”). The person may be warm or may come across as cold or uninterested. By anticipating as many outcomes as possible (as well as how you might cope with each outcome), you will be less likely to be surprised. 正如我们之前讨论的，暴露疗法如果是可预测的，并且你对情境中发生的事情有一定的控制感，效果会更好。因此，最好从那些你大致知道可能会发生什么的暴露练习开始。然而，有些情境本质上是不可预测的。例如，如果你决定邀请另一个人约会，可能无法知道对方会如何回应。在这些情况下，你可以通过事先考虑所有可能发生的结果，使情境变得稍微可预测一些。例如，对方可能会接受你的邀请，拒绝，或者暂时推迟回应（例如，不回你的电话或说“我不确定，让我再考虑一下”）。对方可能表现得热情，也可能显得冷淡或不感兴趣。通过尽可能多地预见各种结果（以及你可能如何应对每种结果），你就不太可能感到惊讶。
Duration of Exposure 暴露持续时间
Exposure works better if it lasts long enough for you to learn that your feared outcome doesn’t occur. We suggest that you try to stay in the situation for as long as possible. For example, if you are at a party, try to stay for at least a couple of hours. If you’re giving a presentation and have the option of making it longer, try to take advantage of the opportunity to speak for a longer time. Ideally, you should stay in the situation until your anxiety decreases to a mild or moderate level. However, even if your anxiety doesn’t decrease during a particular practice, exposure will still likely be helpful, especially if you don’t leave the situation too quickly. 暴露疗法效果更好，前提是持续时间足够长，让你学会害怕的结果并未发生。我们建议你尽量在情境中停留更长时间。例如，如果你在参加聚会，尽量待上至少几个小时。如果你正在做演讲，并且有机会延长时间，尽量利用这个机会多讲一会儿。理想情况下，你应该待在情境中，直到焦虑降低到轻度或中度水平。然而，即使在某次练习中你的焦虑没有减轻，暴露疗法仍然可能有帮助，尤其是如果你没有过快离开该情境。
If you are practicing being in a situation that is naturally very brief (something like asking a stranger for the time or directions), you can prolong the anxiety-provoking situation by repeating the exposure over and over for a longer period. For example, instead of asking one person for information while walking through a shopping mall (“Where is the food court?”), you can ask twenty or thirty different people for the same information over the course of an hour or more. The chances are good that your fear will decrease over time. 如果你正在练习处于一个本来就非常短暂的情境中（比如向陌生人问时间或问路），你可以通过反复多次暴露于这种引发焦虑的情境来延长时间。例如，不是在购物中心走过时只问一个人信息（“美食广场在哪里？”），而是在一个小时或更长时间内向二十到三十个不同的人询问同样的信息。你的恐惧很可能会随着时间的推移而减少。
Frequency of Exposure 暴露的频率
Exposure works better if practices are repeated close together. For example, giving a speech once a week is more effective than giving a speech once a month. Daily speeches will decrease your fear more effectively than once a week, even if the number of practices is the same. In other words, giving a presentation five days in a row will likely lead to a greater decrease in fear than giving a presentation once per week for five consecutive weeks. So, try to schedule practices as frequently as possible. We recommend that you set aside at least an hour to practice exposure on most days. Once your fear has begun to decrease considerably, it is a good idea to gradually spread out the practices to every few weeks or even to every few months, depending on the situation and how often it arises in your day-to-day life. Occasional practices will help to maintain the improvements you have made in decreasing your fear. 暴露疗法如果练习间隔较短，效果会更好。例如，每周做一次演讲比每月做一次更有效。即使练习次数相同，每天演讲也比每周一次更能有效减少你的恐惧。换句话说，连续五天做演讲，通常比连续五周每周做一次演讲更能显著降低恐惧感。因此，尽量安排尽可能频繁的练习。我们建议你在大多数日子里至少留出一个小时来进行暴露练习。一旦你的恐惧开始明显减轻，逐渐将练习间隔延长到每隔几周甚至几个月一次是个好主意，这取决于具体情况以及恐惧在你日常生活中出现的频率。偶尔的练习有助于维持你在减少恐惧方面取得的进步。
Practice in a Variety of Situations 在各种情境中练习
To some extent, working on decreasing your fear in a particular social or performance situation will help you to feel more comfortable in other social situations as well. This process is called generalization, and research has shown that generalization often occurs as a result of exposure. For example, if you learn to feel comfortable asking questions in class, some of that success may “spread,” or generalize, to other situations, making it easier for you to speak up at meetings at work. However, generalization will not cause your success to spread to every situation you fear. Therefore, to get the most out of 在某种程度上，减少你在特定社交或表演场合中的恐惧感，有助于你在其他社交场合中也感到更自在。这个过程称为泛化，研究表明泛化通常是暴露疗法的结果。例如，如果你学会了在课堂上自如地提问，那么这种成功感可能会“扩散”或泛化到其他场合，使你在工作会议上发言变得更容易。然而，泛化不会让你的成功扩散到你害怕的每一个场合。因此，为了最大限度地利用
exposure, it’s best to practice in a variety of different contexts, places, and situations. For example, if you want to be more comfortable making small talk, we recommend that you practice with your coworkers, family members, strangers in the elevator, at parties, and in as many other situations as possible. 暴露疗法，最好在各种不同的环境、地点和情境中进行练习。例如，如果你想在闲聊时更自如，我们建议你在与同事、家人、电梯里的陌生人、聚会以及尽可能多的其他场合中练习。
Choose Practices That Are Challenging but Not Impossible 选择具有挑战性但并非不可能完成的练习
You may feel discouraged if while trying a particular practice, you become anxious or uncomfortable. There is no need to feel discouraged. In fact, it is helpful for you to feel some discomfort during exposure practices. That’s why you are doing the practices in the first place. Over time, you will begin to feel less anxious. A successful practice is one that you complete, regardless of how anxious you feel. 如果在尝试某种练习时感到焦虑或不适，你可能会感到沮丧。但没有必要感到沮丧。事实上，在暴露练习中感到一些不适是有帮助的。这正是你进行这些练习的原因。随着时间的推移，你会开始感到焦虑减少。一次成功的练习是指你完成了练习，无论你感到多么焦虑。
On the other hand, it’s not necessary to choose practices that are completely terrifying or for which you find it impossible to stay in the situation. If a situation seems too difficult, we encourage you to try something easier. But do try something. 另一方面，没有必要选择完全令人恐惧或你觉得无法坚持的练习。如果某个情境看起来太困难，我们鼓励你尝试一些更简单的。但一定要尝试一些东西。
Choose Practices with Minimal Risk 选择风险最小的练习
Choose practices in which the likely consequences are minimal, except for a period of feeling anxious. For example, if you want to be more comfortable with the possibility of seeming foolish or being the center of attention, there are lots of safe practices that you can try (for example, walking around with your shirt inside out, telling the cashier that you have forgotten your wallet when you reach the front of the grocery line). There is no need to take unnecessary risks, such as telling your boss what a jerk he is or yelling out a dirty joke at your best friend’s wedding. If you’re not sure about the realistic risks associated with a particular practice, ask someone whose judgment you trust (perhaps a friend or family member). 选择那些可能后果最小的练习，除了感到焦虑的一段时间。例如，如果你想更自在地面对看起来愚蠢或成为注意中心的可能性，有很多安全的练习可以尝试（例如，穿着反穿的衬衫走来走去，或者在排超市队时告诉收银员你忘带钱包了）。没有必要冒不必要的风险，比如告诉你的老板他是个混蛋，或者在你最好的朋友婚礼上大声讲下流笑话。如果你不确定某个练习的现实风险，可以询问你信任判断的人（比如朋友或家人）。
Measure Your Improvement 衡量你的进步
It will be helpful to assess your anxiety from time to time using the forms and suggestions in chapter 3. Evaluating your improvement periodically will remind you of how far you have come and will also let you know when it is time to move on to new situations. 定期使用第三章中的表格和建议来评估你的焦虑会很有帮助。定期评估你的进步会提醒你已经走了多远，也会让你知道何时该进入新的情境。
Include a Helper or Coach 包括一个助手或教练
Consider including a friend, coworker, or therapist to act as a coach during exposure practices. This individual can help you with role-play practices (for instance, a mock 考虑邀请朋友、同事或治疗师在暴露练习中担任教练。此人可以帮助你进行角色扮演练习（例如，模拟演练）
job interview, practicing making small talk) and can provide you with feedback following your practices. If you choose to include a helper during some exposure exercises, that person should be familiar with the basic principles of exposure. Either you should instruct the person about what their role as helper or coach entails, or you should have the person read the relevant sections of this book. In fact, some combination of both approaches may work best. In addition, the person you choose to work with should be supportive and unlikely to become frustrated if things don’t work out as planned. 工作面试，练习进行闲聊）并且可以在你练习后提供反馈。如果你选择在某些暴露练习中包含一个帮手，那个人应该熟悉暴露的基本原则。你要么应当向该人说明作为帮手或教练的角色职责，要么让他阅读本书相关章节。实际上，两种方法结合起来可能效果最好。此外，你选择合作的人应当支持你，并且如果事情没有按计划进行，也不太可能感到沮丧。
Keep Your Expectations Realistic 保持期望的现实性
Don’t expect your anxiety to change overnight. It will likely take weeks or months for it to improve. Also, you won’t be able to follow your improvement like a straight line on a graph. You may find that in some situations your anxiety decreases fairly quickly, whereas in other situations success takes longer. Also, you may find that some exposure practices don’t lead to any improvement in your fear. You may even have weeks during which your fear and anxiety worsen. A good rule of thumb is to expect one step back for every two or three steps forward. 不要指望你的焦虑会在一夜之间改变。它可能需要数周或数月才能有所改善。此外，你的进步不会像图表上的直线那样持续上升。你可能会发现，在某些情况下你的焦虑会相当快地减少，而在其他情况下成功则需要更长时间。你还可能发现，有些暴露练习并不会带来任何恐惧的改善。你甚至可能经历几周恐惧和焦虑加重的时期。一个好的经验法则是，每前进两到三步，可能会后退一步。
Don't Fight Your Feelings 不要抗拒你的感受
For years, you have probably been trying to control your anxiety, to prevent it from occurring, and to get rid of it as soon as possible-no matter what the cost. By now, you have probably discovered that trying to control your emotions doesn’t work. In fact, attempts to control your anxiety are likely to make it worse rather than better. Fighting your fear is like lying in bed trying hard to fall asleep by a particular time, telling yourself, “I must fall asleep!” Often, the more you try to sleep, the harder it becomes. In fact, for some people who have trouble sleeping, trying to stay awake is a productive strategy. As soon as they stop trying to sleep, they fall asleep quite quickly. 多年来，你可能一直在试图控制自己的焦虑，防止它发生，并尽快摆脱它——无论付出什么代价。到现在，你可能已经发现，试图控制情绪并不起作用。事实上，试图控制焦虑往往会使情况变得更糟，而不是更好。与恐惧作斗争就像躺在床上拼命想在某个特定时间入睡，对自己说：“我必须入睡！”通常，你越是努力入睡，反而越难入睡。事实上，对于一些有睡眠困难的人来说，试图保持清醒是一种有效的策略。一旦他们停止努力入睡，就会很快入睡。
When you can allow yourself to become anxious without fighting the feelings, eventually you will become much more comfortable in social and performance situations. This sounds contradictory, but it really works this way. Instead of fighting your feelings, just let them happen. Instead of evaluating your experiences (for example, “sweating in front of others is unacceptable”), accept them. When practicing exposure, you should observe your responses and experiences without evaluating them. Your fear will likely pass more quickly if you are not trying so hard to get rid of it. Remember, the worst thing that can happen is that you will feel uncomfortable for a while. Being anxious is not dangerous, and anxiety always passes. 当你能够允许自己感到焦虑而不去抗拒这种感觉时，最终你会在社交和表现场合中变得更加自在。这听起来有些矛盾，但事实确实如此。不要抗拒你的感受，只需让它们自然发生。不要评判你的经历（例如，“在别人面前出汗是不可接受的”），而是接受它们。在练习暴露疗法时，你应该观察自己的反应和经历，而不去评判它们。如果你不那么努力地想要摆脱恐惧，你的恐惧很可能会更快消退。记住，最糟糕的情况也不过是你会感到不舒服一段时间。焦虑并不可怕，焦虑总会过去。
As reviewed in chapter 4, variations of cognitive behavioral therapy have recently been developed that emphasize the importance of accepting one’s experiences rather than trying to change them. Examples include mindfulness meditation and a form of psychotherapy called acceptance and commitment therapy (Hayes and Smith 2005). These 正如第四章所述，近年来发展出了一些认知行为疗法的变体，这些疗法强调接受自身体验的重要性，而不是试图改变它们。例子包括正念冥想和一种称为接纳与承诺疗法的心理治疗方法（Hayes 和 Smith 2005）。这些
treatments have been found to be effective for treating certain types of anxiety problems, as well as for preventing depression from returning in people who have recently overcome an episode of depression (Eifert and Forsyth 2005; Orsillo and Roemer 2005; Williams et al. 2007). Learning to accept your uncomfortable feelings rather than fight them will ultimately help you to feel more comfortable in the situations you fear. 治疗已被发现对某些类型的焦虑问题有效，同时也能预防最近克服抑郁发作的人群抑郁症的复发（Eifert 和 Forsyth 2005；Orsillo 和 Roemer 2005；Williams 等 2007）。学会接受你不舒服的感受，而不是与之抗争，最终将帮助你在害怕的情境中感到更加自在。
Eliminate Subtle Avoidance Behaviors 消除细微的回避行为
As discussed earlier in this chapter, it is important that you stop the subtle avoidance strategies you use to feel safer in social and performance situations. For example, if you tend to sit on your hands so people won’t notice them shaking, try letting your hands show. If you avoid talking about yourself when conversing with others, purposely try to talk about your own interests and opinions. For example, mention a book that you’ve recently read or a movie that you’ve seen, and share your opinions. If it’s a best seller or a big hit, and you liked it, try to convey your enthusiasm to the person with whom you’re talking; if you didn’t like it, don’t hide your opinion. Express yourself and take a chance on engaging in an exciting dialogue. 正如本章前面所讨论的，停止使用那些让你在社交和表演场合中感觉更安全的微妙回避策略非常重要。例如，如果你习惯把手放在膝盖上以免别人注意到你的手在发抖，试着让手自然地露出来。如果你在与他人交谈时避免谈论自己，刻意尝试谈论自己的兴趣和观点。例如，提到你最近读过的一本书或看过的一部电影，并分享你的看法。如果那是一本畅销书或一部热门电影，并且你喜欢它，试着向对话对象传达你的热情；如果你不喜欢，也不要隐藏你的观点。表达自己，勇敢尝试参与一场精彩的对话。
Eliminating safety behaviors such as overpreparing for presentations, drinking alcohol at parties, and wearing makeup to hide blushing will help you to learn that social situations can be managed, even without using these strategies and behaviors. 消除诸如为演讲过度准备、在聚会中饮酒以及化妆以掩盖脸红等安全行为，将帮助你学会即使不使用这些策略和行为，也能应对社交场合。
Ending a Practice and Moving On to the Next One 结束一次练习并进入下一次练习
Ideally, an exposure practice should not end before your fear has decreased to a mild or moderate level (such as 20 to 40 on a 0 - to 100 -point scale). Sometimes, this will take a few minutes; other times, it may take several hours. If possible, try to stay in the situation until you feel more comfortable. However, even if your fear doesn’t decrease within a practice, you will still likely benefit from the practice over the long term. 理想情况下，暴露练习不应在你的恐惧降低到轻度或中度水平之前结束（例如，在 0 到 100 分的量表上，恐惧程度降至 20 到 40 之间）。有时，这可能只需几分钟；有时，可能需要几个小时。如果可能，尽量待在该情境中，直到你感觉更舒适为止。然而，即使在一次练习中你的恐惧没有减少，从长远来看，你仍然可能从这次练习中受益。
In reality, you may not always have control over when an exposure practice ends. For example, if you’re practicing eating lunch with coworkers during a half-hour lunch break, you may not have the option of stretching the lunch into two hours just to give your anxiety a chance to decrease. If the situation ends before your anxiety has decreased, try to practice the same situation again as soon as possible. Continue to repeat the practice until it becomes easier. At that point, you can move on to another practice. 实际上，你可能无法总是控制暴露练习的结束时间。例如，如果你在半小时的午休时间里练习与同事共进午餐，你可能无法将午餐时间延长到两个小时，仅仅为了让你的焦虑有机会减轻。如果情境在你的焦虑减轻之前就结束了，尽量尽快再次练习同样的情境。继续重复练习，直到变得更容易。到那时，你可以开始进行另一项练习。
Using Exposure Records and Diaries 使用暴露记录和日记
To get the most out of your exposure practices, we suggest that you use the diaries and forms provided in chapters 8 and 9 to monitor your progress. 为了最大限度地发挥暴露练习的效果，我们建议你使用第 8 章和第 9 章中提供的日记和表格来监测你的进展。
The Aftermath of Exposure: Processing What Happened 暴露后的余波：处理发生的事情
Chances are that you will feel good following your exposure practices. Although you may be tired, you likely will also feel relieved to have completed the practice and proud of your accomplishments. Nevertheless, some people tend to analyze their every move and criticize their performances during the practice (for example, “People surely noticed my anxiety,” “I came across like a bumbling idiot”). If you tend to dwell on what happened during your practices, we suggest that you try to put a more positive spin on the experience. 在完成暴露练习后，你很可能会感觉良好。虽然你可能会感到疲惫，但你也很可能会因为完成了练习而感到宽慰，并为自己的成就感到自豪。然而，有些人倾向于分析自己在练习中的每一个动作，并批评自己的表现（例如，“人们肯定注意到了我的焦虑”，“我表现得像个笨拙的傻瓜”）。如果你倾向于反复思考练习中发生的事情，我们建议你尝试以更积极的角度看待这次经历。
Remember that the main reason you are practicing exposure is to eventually feel more comfortable in social and performance situations. However, for now, expect to feel uncomfortable during practices. Expect that your performance won’t be perfect (in fact, the goal isn’t perfection anyway). Rather than dwelling on what happened or didn’t happen, try to use the cognitive techniques from chapter 6 to challenge your negative thinking. Also, try to take something positive from the experience. Even if things didn’t go the way you had hoped they would, you can still use the experience to plan future practices and to generate ideas for what you might do differently the next time. 请记住，你进行暴露练习的主要原因是为了最终在社交和表演场合中感到更加自在。然而，目前在练习过程中，预期会感到不舒服。预期你的表现不会完美（事实上，目标本来就不是完美）。与其纠结于发生了什么或没发生什么，不如尝试运用第 6 章中的认知技巧来挑战你的消极思维。同时，试着从经历中汲取积极的东西。即使事情没有如你所愿，你仍然可以利用这次经历来规划未来的练习，并为下一次可能采取的不同做法产生想法。
A WORD TO SIGNIFICANT OTHERS, FRIENDS, AND FAMILY MEMBERS 致重要他人、朋友和家人的一段话
If you are reading this book in order to help a loved one, here are a few suggestions to keep in mind. First, your loved one must be on board with this treatment. Treatment is not something that can be forced on someone who isn’t willing to make the necessary changes. In addition, you should avoid the temptation to trick, force, bribe, or coerce a person into doing exposure practices. In order to get the most out of treatment, it’s important that the decision to do exposure comes from the individual. 如果你正在阅读这本书以帮助你所爱的人，这里有一些建议需要记住。首先，你所爱的人必须同意接受这种治疗。治疗不能强加给不愿意做出必要改变的人。此外，你应避免诱使、强迫、贿赂或胁迫某人进行暴露练习。为了最大限度地发挥治疗效果，决定进行暴露练习必须来自个人自身。
Your role in exposure therapy is to help brainstorm possible exposure practices, to provide support, to participate in exposure role-plays (for example, a simulated job interview), and to be involved in actual exposure practices when you’re asked to do so. For example, if your loved one fears attending parties, he may ask you to attend a party with him. If your loved one fears eating in restaurants, she may ask you to join her for a meal. In advance of any exposure practices, discuss with your loved one what he or she would like you to do in the situation (for example, provide reassurance, provide company, probe for anxiety-provoking thoughts, and so on). 你在暴露疗法中的角色是帮助头脑风暴可能的暴露练习，提供支持，参与暴露角色扮演（例如，模拟面试），并在被要求时参与实际的暴露练习。例如，如果你所爱的人害怕参加聚会，他可能会请你陪他一起去。如果你所爱的人害怕在餐馆用餐，她可能会请你陪她一起吃饭。在进行任何暴露练习之前，与所爱的人讨论他或她希望你在情境中做什么（例如，提供安慰、陪伴、探查引发焦虑的想法等）。
SUMMARY OF EXPOSURE GUIDELINES 暴露指导原则总结
This chapter described a long list of guidelines for how to get the most out of your exposure practices. Following is a list of the most important suggestions, in summary form. 本章描述了如何最大限度地利用暴露练习的一长串指导原则。以下是最重要建议的总结列表。
Plan practices in advance. Set aside time to practice exposure. 提前规划练习。预留时间进行暴露练习。
Exposure practices should be predictable and under your control (particularly early in treatment). 暴露练习应是可预测且在你控制之下的（尤其是在治疗初期）。
Exposure should be frequent (almost daily), especially at the start. 暴露应频繁进行（几乎每天），尤其是在开始阶段。
Exposure should be prolonged. Try to stay in the situation until your fear has decreased. 暴露应持续较长时间。尽量待在情境中，直到你的恐惧减轻。
Use cognitive strategies to challenge anxious thoughts before entering the situation. 在进入情境前，使用认知策略来挑战焦虑的想法。
Use cognitive strategies to challenge anxious thoughts during the practice. 在练习过程中，使用认知策略来挑战焦虑的想法。
Use cognitive strategies to challenge anxious thoughts after leaving the situation. 在离开情境后，使用认知策略来挑战焦虑的想法。
Don’t fight your anxious feelings in the situation. Just let the feelings happen. 在情境中不要与焦虑的情绪抗争。只需让这些情绪自然发生。
Eliminate subtle avoidance strategies like distraction, alcohol use, and overprotective behaviors. 消除诸如分心、饮酒和过度保护行为等微妙的回避策略。
Practice in a number of different situations. 在多种不同的情境中进行练习。
Choose practices in which the actual risk is minimal, especially at first. 选择实际风险最小的练习，尤其是在刚开始时。
Choose practices that are challenging, but not impossible. 选择具有挑战性的练习，但不要选择不可能完成的。
Complete exposure records (see chapters 8 and 9) with each practice. 每次练习都要完成暴露记录（参见第 8 章和第 9 章）。
TROUBLESHOOTING 故障排除
Problem: My fear does not decrease during my exposure practices. 问题：在暴露练习中，我的恐惧没有减少。
Solutions: This is normal to some extent. Although anxiety and fear usually decrease during the course of a particular exposure practice, most people experience occasional practices in which their anxiety doesn’t decrease. Here are some suggestions for dealing with this situation. 解决方案：在某种程度上这是正常的。虽然在特定的暴露练习过程中，焦虑和恐惧通常会减少，但大多数人偶尔会遇到焦虑没有减少的练习。以下是应对这种情况的一些建议。
Make sure that you are staying in the situation long enough. Sometimes it can take several hours for a person’s fear to diminish. 确保你在情境中停留的时间足够长。有时一个人的恐惧可能需要几个小时才能减轻。
Make sure that you are not using subtle avoidance strategies. The normal pattern during exposure is for fear to increase and then gradually to decrease. Using subtle avoidance strategies such as distraction 确保你没有使用微妙的回避策略。暴露过程中的正常模式是恐惧先增加，然后逐渐减少。使用诸如分散注意力等微妙的回避策略会影响效果。
may cause the fear to go up and down repeatedly over the course of the practice, because most people are not very good at distracting themselves for long periods. 在练习过程中，恐惧感可能会反复升高和降低，因为大多数人不擅长长时间分散自己的注意力。
Negative thinking can sometimes interfere with the effects of exposure. If your fear does not decrease during a particular exposure practice, challenge your anxious thoughts using the techniques described in chapter 6. 消极思维有时会干扰暴露疗法的效果。如果在某次暴露练习中你的恐惧没有减轻，请使用第 6 章中描述的技巧来挑战你的焦虑想法。
If all else fails, just keep practicing. Sometimes it takes repeated exposure practices before a person’s fear begins to lessen. 如果其他方法都无效，就继续练习。有时需要多次暴露练习，恐惧感才会开始减轻。
Problem: My fear returns between exposure practices. 问题：我的恐惧在暴露练习之间会反复出现。
Solution: This is normal for most people. With more and more practice, your fear will decrease more quickly during practices and will not return as intensely between them. One way of preventing your fear from returning between exposures is to increase the frequency of your practices, particularly early in treatment. 解决方案：这对大多数人来说是正常的。随着练习次数的增加，你的恐惧在练习过程中会更快减轻，并且在练习之间不会以同样强烈的程度出现。防止恐惧在暴露之间复发的一种方法是增加练习的频率，尤其是在治疗初期。
Problem: My physical symptoms (for instance, stuttering, shaking, sweating) are very noticeable. 问题：我的身体症状（例如口吃、颤抖、出汗）非常明显。
Solution: Remember that, despite how it seems to you, the chances are good that your symptoms are not as noticeable to others as you think they are. Furthermore, as your anxiety decreases, the intensity of these symptoms will likely decrease. If you are concerned about people noticing your symptoms, use the cognitive techniques from chapter 6 to challenge your anxious thinking. Remember that there are lots of people who blush, shake, or lose their train of thought and who couldn’t care less about what other people think. The problem is not that you experience these symptoms, but rather your beliefs about the consequences of having these symptoms. 解决方案：请记住，尽管你觉得很明显，但你的症状对他人来说可能没有你想象的那么明显。此外，随着你的焦虑减轻，这些症状的强度也可能会降低。如果你担心别人注意到你的症状，可以使用第 6 章中的认知技巧来挑战你的焦虑思维。记住，有很多人会脸红、颤抖或忘词，但他们根本不在乎别人怎么想。问题不在于你出现这些症状，而在于你对这些症状后果的信念。
Problem: I am just not good at qquad\qquad (making small talk, public speaking, and so on). 问题：我就是不擅长 qquad\qquad （闲聊、公开演讲等等）。
Solution: Your social skills are likely much better than you think they are. As discussed in earlier chapters, people who are socially anxious tend to be overly critical of their social and performance skills. Nevertheless, there may be ways in which certain skills can be improved. It is likely that exposure alone will contribute to an improvement of your skills. For example, practicing making small talk will help you to learn what works during a casual conversation and what doesn’t. In addition, we suggest that you read chapter 10, which includes specific strategies for improving social and communication skills. 解决方案：你的社交技能很可能比你想象的要好得多。正如前面章节所讨论的，社交焦虑的人往往对自己的社交和表现技能过于苛刻。然而，某些技能可能仍有改进的空间。单纯的暴露（练习）很可能会促进你的技能提升。例如，练习闲聊可以帮助你了解在日常对话中什么有效，什么无效。此外，我们建议你阅读第 10 章，其中包含了改善社交和沟通技能的具体策略。
Problem: 问题：
My fear is too high to benefit from exposure. 我的恐惧感太强，无法从暴露中受益。
Solutions: 解决方案：
Ideally, you should choose practices that arouse a fear level of 70 to 80 out of 100 , although it is also okay if your fear reaches even higher levels. One method for keeping your fear in check is to use the cognitive strategies from chapter 6 to challenge your anxious thoughts before entering the situation. At times, however, even using the cognitive techniques beforehand won't prevent your fear from becoming very intense. 理想情况下，你应该选择那些引发 70 到 80 分（满分 100 分）恐惧感的练习，尽管如果你的恐惧感甚至更高也没关系。控制恐惧感的一种方法是，在进入情境之前，使用第 6 章中的认知策略来挑战你的焦虑想法。然而，有时即使事先使用认知技巧，也无法阻止你的恐惧变得非常强烈。
If you find that your fear is completely overwhelming, you have three options. First, you can try to wait a while longer to see if your fear decreases. Alternatively, you may consider taking a short break and then trying the same exercise again. Finally, you can try switching to a less difficult practice. Any of these approaches is usually fine. The main point is not to give up completely. 如果你发现恐惧感完全压倒了你，你有三个选择。首先，你可以尝试再等一会儿，看看恐惧感是否会减轻。或者，你可以考虑短暂休息一下，然后再尝试同样的练习。最后，你可以尝试换一个难度较低的练习。这些方法通常都可以。关键是不要完全放弃。
Problem: 问题：
The situations that I fear are very brief in duration, so there isn't enough time for my fear to decrease. 我害怕的情境持续时间非常短，所以没有足够的时间让我恐惧感减轻。
Solution: 解决方案：
This issue was discussed earlier in the chapter, but it's worth highlighting again here. Ideally, if an exposure practice is brief, you should try to find creative ways to lengthen the duration of the practice, if possible. For example, if you are fearful of chatting with the cashier at the front of a supermarket line, try lining up repeatedly over the course of an hour or two and buying only a few items at a time. This approach will give you more opportunities to talk to the cashiers, compared with paying for all your groceries at once. 这个问题在本章前面已经讨论过，但这里值得再次强调。理想情况下，如果暴露练习时间较短，应该尽可能想办法延长练习的持续时间。例如，如果你害怕在超市排队时与收银员交谈，可以尝试在一两个小时内多次排队，每次只买几件商品。与一次性结清所有购物相比，这种方法会给你更多与收银员交谈的机会。
Problem: 问题：
I just had something terrible happen during an exposure practice (for example, my boss criticized my presentation). How can I ever try exposure again? 我在一次暴露练习中遇到了糟糕的事情（例如，我的老板批评了我的演讲）。我怎么还能再尝试暴露练习呢？
Solutions: 解决方案：
Although rare, it is possible that an unexpected negative event will occur during an exposure practice. For example, you could experience a bad panic attack during a job interview, or you may be laughed at during a presentation. If something bad does happen during an exposure practice, it's natural for some of your fear to return. It may be helpful to "rethink" the meaning of the negative event using the cognitive techniques described in chapter 6. In addition, we recommend that you resume your exposure practices. If necessary, you can return to a previous item in your hierarchy and work your way back to where you were when the unfortunate incident took place. 虽然很少见，但在暴露练习过程中可能会发生意外的负面事件。例如，你可能在面试时经历严重的恐慌发作，或者在演讲时被嘲笑。如果在暴露练习中发生了不好的事情，你的部分恐惧感恢复是很自然的。利用第 6 章中描述的认知技巧“重新思考”负面事件的意义可能会有所帮助。此外，我们建议你继续进行暴露练习。如有必要，你可以回到层级中的前一项，逐步回到不幸事件发生时的位置。
Problem: My fear is too high to benefit from exposure.
Solutions: Ideally, you should choose practices that arouse a fear level of 70 to 80 out of 100 , although it is also okay if your fear reaches even higher levels. One method for keeping your fear in check is to use the cognitive strategies from chapter 6 to challenge your anxious thoughts before entering the situation. At times, however, even using the cognitive techniques beforehand won't prevent your fear from becoming very intense.
If you find that your fear is completely overwhelming, you have three options. First, you can try to wait a while longer to see if your fear decreases. Alternatively, you may consider taking a short break and then trying the same exercise again. Finally, you can try switching to a less difficult practice. Any of these approaches is usually fine. The main point is not to give up completely.
Problem: The situations that I fear are very brief in duration, so there isn't enough time for my fear to decrease.
Solution: This issue was discussed earlier in the chapter, but it's worth highlighting again here. Ideally, if an exposure practice is brief, you should try to find creative ways to lengthen the duration of the practice, if possible. For example, if you are fearful of chatting with the cashier at the front of a supermarket line, try lining up repeatedly over the course of an hour or two and buying only a few items at a time. This approach will give you more opportunities to talk to the cashiers, compared with paying for all your groceries at once.
Problem: I just had something terrible happen during an exposure practice (for example, my boss criticized my presentation). How can I ever try exposure again?
Solutions: Although rare, it is possible that an unexpected negative event will occur during an exposure practice. For example, you could experience a bad panic attack during a job interview, or you may be laughed at during a presentation. If something bad does happen during an exposure practice, it's natural for some of your fear to return. It may be helpful to "rethink" the meaning of the negative event using the cognitive techniques described in chapter 6. In addition, we recommend that you resume your exposure practices. If necessary, you can return to a previous item in your hierarchy and work your way back to where you were when the unfortunate incident took place.| Problem: | My fear is too high to benefit from exposure. |
| :--- | :--- |
| Solutions: | Ideally, you should choose practices that arouse a fear level of 70 to 80 out of 100 , although it is also okay if your fear reaches even higher levels. One method for keeping your fear in check is to use the cognitive strategies from chapter 6 to challenge your anxious thoughts before entering the situation. At times, however, even using the cognitive techniques beforehand won't prevent your fear from becoming very intense. |
| | If you find that your fear is completely overwhelming, you have three options. First, you can try to wait a while longer to see if your fear decreases. Alternatively, you may consider taking a short break and then trying the same exercise again. Finally, you can try switching to a less difficult practice. Any of these approaches is usually fine. The main point is not to give up completely. |
| Problem: | The situations that I fear are very brief in duration, so there isn't enough time for my fear to decrease. |
| Solution: | This issue was discussed earlier in the chapter, but it's worth highlighting again here. Ideally, if an exposure practice is brief, you should try to find creative ways to lengthen the duration of the practice, if possible. For example, if you are fearful of chatting with the cashier at the front of a supermarket line, try lining up repeatedly over the course of an hour or two and buying only a few items at a time. This approach will give you more opportunities to talk to the cashiers, compared with paying for all your groceries at once. |
| Problem: | I just had something terrible happen during an exposure practice (for example, my boss criticized my presentation). How can I ever try exposure again? |
| Solutions: | Although rare, it is possible that an unexpected negative event will occur during an exposure practice. For example, you could experience a bad panic attack during a job interview, or you may be laughed at during a presentation. If something bad does happen during an exposure practice, it's natural for some of your fear to return. It may be helpful to "rethink" the meaning of the negative event using the cognitive techniques described in chapter 6. In addition, we recommend that you resume your exposure practices. If necessary, you can return to a previous item in your hierarchy and work your way back to where you were when the unfortunate incident took place. |
Problem: I don’t avoid the situation, and yet my fear persists. 问题：我并没有回避这种情况，但恐惧依然存在。
Solutions: Although exposure usually leads to a decrease in fear, occasionally people report having intense fear in social situations despite almost never avoiding these situations. For example, a person may eat with others on a regular basis but still get anxious in the situation. If you continue to experience fear, despite never avoiding the feared situation, you may find it difficult to come up with appropriate exposure exercises. Here are three strategies to consider. 解决方案：虽然暴露通常会导致恐惧感减轻，但偶尔有人报告即使几乎从不回避社交场合，仍会在社交场合中感到强烈的恐惧。例如，一个人可能经常与他人一起吃饭，但在这种情况下仍会感到焦虑。如果你持续感到恐惧，尽管从未回避过害怕的情境，你可能会发现很难想出合适的暴露练习。这里有三种策略可供考虑。
First, if you fear experiencing arousal symptoms while in social situations, try the interoceptive exposure exercises discussed in chapter 9. Second, assess whether you are engaging in subtle avoidance strategies, overprotective behaviors, alcohol or drug use, or other strategies that may be undermining the effects of the exposure. If so, try to discontinue these behaviors. Finally, a special effort should be used to identify and challenge the anxious predictions and beliefs that continue to maintain your fear (see chapter 6). 首先，如果你害怕在社交场合中出现唤醒症状，尝试第 9 章中讨论的内感受暴露练习。其次，评估自己是否在进行微妙的回避策略、过度保护行为、酒精或药物使用，或其他可能削弱暴露效果的策略。如果是，尝试停止这些行为。最后，应特别努力识别并挑战那些持续维持你恐惧的焦虑预测和信念（见第 6 章）。
CHAPTER 8 第 8 章
Exposure to Social Situations 社交场合的暴露
In chapter 7, we provided an overview of the basic principles underlying exposure-based treatments for social anxiety. In this chapter, we’ll present additional information about how to use these strategies to confront the social and performance situations that make you anxious or uncomfortable. You should be very familiar with the material in chapter 7 before moving on to this chapter. As noted earlier, we suggest that you use the cognitive strategies described in chapter 6 to combat anxious thinking before, during, and after exposure practices. During practices, you should refrain from using subtle avoidance techniques such as distraction, drugs or alcohol, and safety behaviors (for example, eating in a dimly lit restaurant so people don’t notice your blushing). Finally, a reminder that exposure works best when practices are: 在第 7 章中，我们概述了基于暴露疗法治疗社交焦虑的基本原理。在本章中，我们将提供更多关于如何使用这些策略来面对让你感到焦虑或不适的社交和表演情境的信息。在进入本章之前，你应当非常熟悉第 7 章的内容。如前所述，我们建议你在暴露练习的前、中、后阶段使用第 6 章中描述的认知策略来对抗焦虑思维。在练习过程中，应避免使用诸如分散注意力、药物或酒精以及安全行为（例如，在灯光昏暗的餐厅吃饭以避免别人注意到你的脸红）等微妙的回避技巧。最后提醒，暴露疗法效果最佳的练习应当是：
Frequent (daily, if possible) 频繁的（如果可能，每天进行）
Prolonged (until the anxiety decreases) 持续的（直到焦虑减轻）
Predictable and controllable 可预测且可控制的
Planned in advance 事先计划好的
Conducted in a variety of different situations 在各种不同的情境中进行
SITUATIONAL EXPOSURE PRACTICES 情境暴露练习
This section provides suggestions for exposure practices involving different types of social and performance situations, including public speaking, making small talk, meeting new friends and dating, situations involving conflict with others, being the center of 本节提供了涉及不同类型社交和表演情境的暴露练习建议，包括公开演讲、闲聊、结识新朋友和约会、涉及与他人冲突的情境、成为焦点的情况
attention, eating and drinking in public, writing in front of others, job interviews, being in public, and talking to people in authority. In addition to the suggestions provided here, there is space in each section for you to record additional ideas for practices that might be relevant to your own social and performance anxiety. 注意力、在公共场合吃喝、在他人面前写作、求职面试、出现在公共场所以及与权威人士交谈。除了这里提供的建议外，每个部分还留有空间，供你记录可能与你自身社交和表现焦虑相关的额外练习想法。
At first, many of the items suggested in this section may seem overwhelming. However, as suggested in chapter 7, you should begin with challenging but manageable practices. Over time, you will become more comfortable and most likely you will be able to try some of the more difficult practices. In addition, some of these practices may seem very easy to you. If you have no trouble with a particular type of social or performance situation, there is no need to practice confronting it. Instead, focus on the situations that are anxiety-provoking for you. 起初，本节中建议的许多项目可能会让人感到不知所措。然而，正如第 7 章所建议的，你应从具有挑战性但可管理的练习开始。随着时间的推移，你会变得更加自如，并且很可能能够尝试一些更困难的练习。此外，有些练习对你来说可能非常简单。如果你在某种特定的社交或表现情境中没有困难，就无需练习去面对它。相反，应专注于那些让你感到焦虑的情境。
Practices Involving Public Speaking 涉及公开演讲的练习
To overcome a fear of speaking in front of others, it is helpful to take advantage of opportunities that come up during the course of your job or other activities in your day-to-day life. If public speaking opportunities don’t normally arise in your life, there are many ways of creating these situations. Some of these include the following: 为了克服在他人面前讲话的恐惧，利用工作或日常生活中的机会是很有帮助的。如果你的生活中通常没有公开演讲的机会，也有许多方法可以创造这些情境。其中一些包括：
Speak up in meetings at work. For example, share your opinions about issues being discussed. Ask and answer questions. If the opportunity to make a brief presentation arises, take advantage of it. 在工作会议中大胆发言。例如，分享你对讨论问题的看法。提问和回答问题。如果有机会做简短的演讲，要抓住它。
Offer to give a presentation at work or in another situation. For example, if you belong to a book club or reading group, offer to present a summary of the book that your group is reading. If you have some special expertise, offer to share it with your coworkers, colleagues, or friends by giving a formal presentation. 主动提出在工作或其他场合做演讲。例如，如果你参加读书会或阅读小组，可以主动做一次你们正在阅读的书的总结介绍。如果你有某方面的专长，可以通过正式演讲与同事、朋友分享。
Go to a public lecture and ask questions. Public lectures are often advertised in the newspaper, on the Internet, on the radio, or on television (for example, on your local cable access channel). Also, check out advertisements on community bulletin boards and posters at the library, supermarket, local colleges, or other public places. 参加公开讲座并提问。公开讲座通常会在报纸、互联网、广播或电视（例如本地有线电视频道）上宣传。同时，也可以关注社区公告栏、图书馆、超市、本地大学或其他公共场所的海报广告。
Take a course at a college, university, or any school that offers adult education courses. Try to choose courses that provide the opportunity to give presentations. If these are not available, make a point of asking questions several times during each class. If you are unable to enroll in a course, another option is to simply audit or sit in on a large class at a local university. Professors will sometimes give guests permission to observe a class without formally enrolling. Often, undergraduate classes contain hundreds of students, so no one would notice an extra person in the room. Auditing 在大学、学院或任何提供成人教育课程的学校选修一门课程。尽量选择那些提供演讲机会的课程。如果没有这样的课程，务必在每节课上多次提问。如果无法报名参加课程，另一种选择是旁听或旁观当地大学的大型课程。教授有时会允许客人未经正式注册就旁听课程。通常，本科课程有数百名学生，因此教室里多一个人也不会被注意到。旁听
a large class will save you from having to pay registration fees while still providing you with an opportunity to ask questions in public. 大型课程可以免去注册费，同时仍然为你提供在公开场合提问的机会。
Make an impromptu speech or toast at a wedding, party, group dinner, or other social gathering. If you are invited to a party or are planning to have a party of your own, offer to make a short speech in front of the other guests. 在婚礼、聚会、团体晚餐或其他社交场合即兴发表演讲或祝酒词。如果你被邀请参加聚会，或者计划举办自己的聚会，可以主动提出在其他宾客面前做一个简短的演讲。
Take a public speaking course. There are numerous companies that offer public speaking courses (especially for businesspeople). These classes are sometimes expensive, but it may be worth finding out more about the available options (perhaps your workplace would help to cover the costs). Check the Internet or your local Yellow Pages to learn about courses. There are many options available, including, for example, courses by Dale Carnegie Training (www.dalecarnegie.com) and The Leader’s Institute (www.leaders institute.com). 参加公共演讲课程。有许多公司提供公共演讲课程（尤其是针对商务人士）。这些课程有时价格较高，但了解可用的选项可能是值得的（也许你的工作单位会帮助承担费用）。可以通过互联网或本地的黄页查询课程信息。有许多选择，例如戴尔·卡耐基培训（www.dalecarnegie.com）和领导者学院（www.leadersinstitute.com）提供的课程。
Join Toastmasters International. Toastmasters is an organization that holds meetings for individuals who are interested in learning to speak more effectively in front of others. They have more than 11,000 clubs located in ninety countries around the world. Typically, groups include about twenty individuals who meet for one to two hours each week. Annual membership is inexpensive. For more information, visit www.toastmasters.org. 加入国际演讲会。国际演讲会是一个为有兴趣学习如何更有效地在他人面前演讲的人举办会议的组织。他们在全球九十个国家拥有超过 11,000 个俱乐部。通常，每个小组约有二十人，每周聚会一到两个小时。年费会员费用低廉。欲了解更多信息，请访问 www.toastmasters.org。
Take a drama or music class. Taking a theater, drama, or music class will provide you with opportunities to perform in front of others. Classes may be available at local high schools or colleges, professional theater or music schools, the YMCA, or through other agencies. 参加戏剧或音乐课程。参加戏剧、表演或音乐课程将为你提供在他人面前表演的机会。课程可能在当地的高中或大学、专业戏剧或音乐学校、基督教青年会（YMCA）或其他机构提供。
Give a lecture at a local elementary school, high school, or college about your work. Sometimes schools will hold career days through which students have opportunities to learn about particular jobs or careers. Additionally, teachers sometimes invite guests to speak to their classes about particular types of careers or jobs. Call a local school principal to find out about opportunities in your neighborhood school. Or, if you have a child in school, you may have the opportunity to speak to his or her class about what you do at work. 在当地的小学、高中或大学做关于你工作的讲座。有时学校会举办职业日，学生有机会了解特定的工作或职业。此外，老师有时会邀请嘉宾到班级讲述特定类型的职业或工作。打电话给当地学校的校长，了解你所在社区学校的相关机会。或者，如果你有孩子在学校，你也可能有机会向他或她的班级介绍你的工作内容。
Read a passage in front of others. For some people, reading a newspaper article or a passage from a book in front of a few family members may be anxiety provoking. For others, it may be important to try something more challenging, such as reading an introduction for a guest speaker who is about to give a presentation at your workplace. 在他人面前朗读一段文字。对一些人来说，在几位家人面前朗读一篇报纸文章或书中的一段文字可能会引发焦虑。对另一些人来说，尝试更具挑战性的事情可能更重要，比如在工作场所为即将做演讲的嘉宾做开场介绍。
Now, can you think of other possible practices that involve public speaking? If so, record them in the space below: 现在，你能想到其他可能涉及公开演讲的练习吗？如果能，请在下面的空白处记录下来：
Other Practices 其他练习
Practices Involving Making Small Talk, Casual Conversation, and Informal Socializing 涉及闲聊、随意对话和非正式社交的练习
Casual conversation and small talk can take place anywhere. The list below provides a few examples of situations where you might have the opportunity to practice these skills. In addition to planning several large practices per week, you should try to engage in several mini-practices throughout the day. 闲聊和随意对话可以在任何地方进行。下面的列表提供了一些你可能有机会练习这些技能的情境。除了每周计划几次大型练习外，你还应该尝试在一天中进行多次小型练习。
Have friends over for a get-together. For example, invite several coworkers over for dinner or to watch a movie or sports event on TV. Or, have a birthday party for a friend or family member. Make sure that you interact with your guests! Don’t come up with excuses to avoid them (like serving food and drinks to the exclusion of conversation, cleaning up, or washing the dishes). 邀请朋友来家里聚会。例如，邀请几位同事来家里吃晚饭，或者一起看电影或电视上的体育赛事。或者，为朋友或家人举办生日派对。确保你与客人互动！不要找借口避免与他们交流（比如只顾着端菜倒饮料而不聊天，或者忙着打扫和洗碗）。
Speak to strangers on elevators, while waiting in lines, at bus stops, or at other public locations. With repeated practice, making small talk will become easier. Prolonged exposure works best, so try to talk to many different people over the course of an hour or two to get the most benefit. Smile, say hello, and use humor, if appropriate. Although you should be prepared for some people to react negatively (remember, other people may also be shy or they may be uninterested in making small talk), most people will probably react positively. 在电梯里、排队时、公交车站或其他公共场所与陌生人交谈。通过反复练习，闲聊会变得更容易。长时间的接触效果最好，所以尽量在一两个小时内与许多不同的人交谈，以获得最大收益。微笑，打招呼，适当时使用幽默。虽然你要准备好面对一些人的负面反应（记住，其他人可能也很害羞，或者对闲聊不感兴趣），但大多数人可能会有积极的反应。
Ask for directions or for the time. Walk up to a stranger in a mall or store and ask what time it is. Or, ask how to find a particular location. As mentioned earlier, prolonged exposure works best, so try to do this repeatedly over an hour or two or until your anxiety decreases. 问路或询问时间。走到商场或商店里的陌生人面前，问问现在几点了。或者，询问如何找到某个特定地点。如前所述，长时间的暴露效果最好，所以尽量在一两个小时内反复进行，直到你的焦虑减轻。
Talk to coworkers or classmates. Try arriving at school or work a bit early so that you will have the opportunity to chat with others. Make a point of saying hello to your coworkers or classmates during breaks. Simple questions such as, “How was your weekend?” are often a great way to get a conversation started. 与同事或同学交谈。试着提前一点到学校或工作，这样你就有机会和别人聊天。休息时刻意向同事或同学打招呼。简单的问题，比如“你周末过得怎么样？”通常是开启对话的好方法。
Talk to dog owners who are walking their dogs. Dog owners often love to talk about their dogs. If you have a dog, try going for walks in areas where other people walk their pets. Make comments or ask questions about other people’s dogs (for example, “Nice dog” or “What kind of dog is that?”). If you return to the same routes frequently, you will likely see the same people over and over again. You may even make some new friends. 与遛狗的狗主人交谈。狗主人通常喜欢谈论他们的狗。如果你有狗，试着去那些其他人也带宠物散步的地方。对别人的狗发表评论或提问（例如，“狗真漂亮”或“那是什么品种的狗？”）。如果你经常走同样的路线，很可能会一再遇到同样的人，甚至可能结交一些新朋友。
Talk to cashiers or other staff personnel in stores. For example, comment on the weather, ask for advice or information (“Does this shirt go with these pants?”), or special order a book or CD. 与收银员或商店的其他工作人员交谈。例如，评论天气，询问建议或信息（“这件衬衫和这条裤子搭配吗？”），或者特别订购一本书或一张 CD。
Give or receive compliments. Offer someone else a compliment. For example, tell a coworker that you like her sweater or new haircut, tell an artist that you like his work, or compliment a waiter on the quality of your food. If you are uncomfortable receiving compliments, just say “Thank you” when someone praises you. Don’t discount the praise by telling the person all the reasons why you don’t deserve it. 给予或接受赞美。向别人表达赞美。例如，告诉同事你喜欢她的毛衣或新发型，告诉艺术家你喜欢他的作品，或者赞美服务员你食物的质量。如果你不习惯接受赞美，当有人称赞你时，只需说“谢谢”。不要通过告诉对方你不配得到赞美的各种理由来贬低赞美。
Express a controversial opinion. If you have a controversial opinion about some issue, express it, particularly in situations where the consequences are likely to be minimal. For example, if you didn’t like a movie that someone else is raving about, let them know what you didn’t like about the film. If you disagree with someone else’s political views, explain your perspective on the issue. Try not to put down the other person or to discount that person’s views when you are expressing your own opinions. Differing views should be expressed in a friendly and supportive way, and you should make an effort to communicate understanding of the other person’s perspective. 表达一个有争议的观点。如果你对某个问题有争议的看法，尤其是在后果可能很小的情况下，勇敢表达出来。例如，如果你不喜欢别人极力称赞的一部电影，可以告诉他们你不喜欢这部电影的原因。如果你不同意别人的政治观点，可以解释你对该问题的看法。表达自己观点时，尽量不要贬低对方或否定对方的观点。不同的看法应以友好和支持的方式表达，并且你应努力理解对方的立场。
Join an ongoing conversation. In some circumstances, it is perfectly appropriate to join an ongoing conversation. For example, at parties people often walk about, moving in and out of different conversations. See if you can join in with a group of people who are discussing some issue that interests you. 加入正在进行的对话。在某些情况下，加入正在进行的对话是完全合适的。例如，在聚会中，人们常常走动，进出不同的谈话。看看你是否能加入一群正在讨论你感兴趣话题的人。
Talk to parents of other children. Just as pet owners enjoy talking to other pet owners, parents usually enjoy talking about their children with other parents. If you have children, get involved in situations where you might have the opportunity to talk to other parents. For example, attend parents’ night at your children’s school or enroll your children in a class (such as swimming, hockey, crafts, music) with other children. Take advantage of any opportunities to talk to the other parents. 与其他孩子的父母交谈。就像宠物主人喜欢与其他宠物主人交谈一样，父母通常也喜欢与其他父母谈论他们的孩子。如果你有孩子，参与一些可能有机会与其他父母交谈的场合。例如，参加孩子学校的家长之夜，或者让孩子报名参加与其他孩子一起的课程（如游泳、曲棍球、手工艺、音乐）。利用任何与其他父母交谈的机会。
Meet two or three friends at a café. Invite several coworkers or friends to meet you after work or school for a coffee, drink, or snack. Alternatively, invite others to join you for lunch. 在咖啡馆与两三位朋友见面。邀请几位同事或朋友在下班或放学后一起喝咖啡、饮料或吃点心。或者，邀请别人一起共进午餐。
Can you think of other possible practices that involve informal socializing, casual conversation, or making small talk? If so, record them in the space below: 你能想到其他涉及非正式社交、随意交谈或寒暄的可能做法吗？如果有，请在下面的空白处记录：
Other Practices 其他做法
Practices Involving Meeting New Friends and Dating 结识新朋友和约会的练习
Many of the situations listed in the previous section on practices involving small talk and casual conversation also provide opportunities to meet new people. Similarly, several of the situations listed in this section also provide opportunities for casual conversation. Most new friendships and relationships start with a casual conversation, so it’s no surprise that these sections might overlap. Also, developing new relationships often requires repeated encounters with new people you meet. In other words, two people will typically become acquaintances before they become friends. The list below provides examples of practices that involve a possibility of meeting new people, developing new friendships, developing new business relationships, or fostering opportunities for dating. Remember that the main goal of an exposure practice should be to become more comfortable in these situations. For now, developing new relationships should be a secondary goal. Focus on the process of reducing your fear rather than whether you develop new friends or relationships through these practices. 前一节中关于小谈话和随意交谈的练习中列出的许多情境也提供了结识新人的机会。同样，本节中列出的几个情境也提供了随意交谈的机会。大多数新的友谊和关系都是从随意交谈开始的，因此这两个部分可能会有重叠也不足为奇。此外，发展新关系通常需要与新认识的人多次接触。换句话说，两个人通常会先成为熟人，然后才会成为朋友。下面的列表提供了涉及结识新朋友、发展新友谊、建立新的商业关系或促进约会机会的练习示例。请记住，暴露练习的主要目标应该是在这些情境中变得更加自如。现在，发展新关系应是次要目标。专注于减少恐惧的过程，而不是通过这些练习是否结交新朋友或建立新关系。
Go to a social event. For example, attend your annual office holiday party, a class reunion, a community dance, a local art gallery opening, or a book signing. Situations such as these will provide you with opportunities to meet people, as well as to mingle and make small talk. Be sure to take social risks in these situations (for example, talking to other people). 参加社交活动。例如，参加你每年的办公室假日聚会、同学聚会、社区舞会、本地艺术画廊开幕式或签书会。这类场合会为你提供结识新朋友的机会，同时也能让你与人交往并进行简短的交谈。务必在这些场合中勇于承担社交风险（例如，与他人交谈）。
Talk to your neighbors. Go for walks in the neighborhood and say hello to your neighbors-particularly those you have not had a chance to meet. If you have a new neighbor, consider asking him or her over for a drink or dessert. Invite some of your other neighbors as well. 与邻居交谈。去社区散步，向邻居打招呼——尤其是那些你还没有机会认识的邻居。如果你有新邻居，可以考虑邀请他或她来家里喝饮料或吃甜点。也可以邀请其他邻居一起。
Join a club, take a class, or join an organization. For example, join a bowling league, aerobics class, volleyball league, bingo group, self-help group, church group, art class, or other group. Ideally, the group should meet frequently (for instance, weekly) for you to get the most benefit from attending it. 加入俱乐部、参加课程或加入组织。例如，加入保龄球联赛、有氧运动班、排球联赛、宾果游戏组、自助小组、教会团体、艺术班或其他团体。理想情况下，该团体应经常聚会（例如每周一次），这样你才能从中获得最大收益。
Ask friends or colleagues to introduce you to new people. Take advantage of opportunities to meet new people through friends, coworkers, or other people you know. 请朋友或同事介绍你认识新朋友。利用通过朋友、同事或你认识的其他人结识新朋友的机会。
Invite people you know to socialize. For example, invite several coworkers or acquaintances for lunch, dinner, a movie, or a concert. Or, invite several coworkers or acquaintances away on a vacation, ski weekend, or conferencerelated trip. 邀请你认识的人一起社交。例如，邀请几位同事或熟人共进午餐、晚餐、看电影或参加音乐会。或者，邀请几位同事或熟人一起去度假、滑雪周末或参加与会议相关的旅行。
Meet people through online social networks or dating services. Consider joining an online social networking site, such as Facebook (www.facebook .com) or MySpace (www.myspace.com). Join online chat rooms. Meet people through online dating services (for example, www.match.com). Two cautions: first, although the Internet can be a useful tool for meeting people, it’s important that you not rely exclusively on online relationships instead of in-person relationships. Rather, consider using the Internet as a tool for meeting people who you might eventually meet in person. Second, if you are meeting people in person for the first time, use appropriate caution. For example, a first date should happen in a public place, and you should not give others your home address until you know them fairly well. 通过在线社交网络或约会服务认识人。可以考虑加入在线社交网站，如 Facebook（www.facebook.com）或 MySpace（www.myspace.com）。加入在线聊天室。通过在线约会服务认识人（例如，www.match.com）。有两个注意事项：首先，虽然互联网可以成为认识人的有用工具，但重要的是不要仅依赖在线关系而忽视面对面的人际关系。相反，应将互联网视为认识可能最终会见面的人们的工具。其次，如果是第一次与人面对面见面，应采取适当的谨慎措施。例如，第一次约会应在公共场所进行，且在较为了解对方之前，不应向他人透露你的家庭住址。
Arrange for dates through personal ads or dating services. In addition to meeting people through the Internet, you can also find opportunities for dating through professional dating services and through personal ads in local newspapers. 通过个人广告或约会服务安排约会。除了通过互联网认识人之外，你还可以通过专业的约会服务和当地报纸上的个人广告找到约会的机会。
Can you think of other possible practices that involve meeting new friends, dating, or related situations? If so, record them in the space below: 你能想到其他可能涉及结识新朋友、约会或相关情境的做法吗？如果有，请在下面的空白处记录：
Other Practices 其他做法
Practices Involving Possible Conflict with Others 可能与他人发生冲突的做法
These practices should be planned carefully. Unlike the other practices recommended in this chapter, these are likely to cause another person to become a bit angry or impatient with your behavior. Choose practices in which the risks are minimal-if you are unsure of the risks, ask a friend or family member for a second opinion. You may also 这些练习应当经过仔细规划。与本章推荐的其他练习不同，这些练习可能会让别人对你的行为感到有些生气或不耐烦。请选择风险较小的练习——如果你不确定风险，可以请朋友或家人帮忙评估。你也可以
want to skip ahead to the sections on assertive communication in chapter 10 to prepare yourself for this kind of interaction. It’s important that potential conflict situations be dealt with assertively rather than with aggression, which is likely to escalate the other person’s anger. 提前阅读第 10 章中关于自信沟通的部分，为这类互动做好准备。重要的是，潜在的冲突情境应以自信的方式处理，而非以攻击性方式，因为攻击性很可能会激化对方的愤怒。
It may seem rude to do things purposefully that will inconvenience others. On the other hand, as you continue to read this section, you will see that most of these practices involve only minor inconvenience to other people, and many of these are situations that people often encounter anyway. The substantial gains that you may obtain from these practices are likely to outweigh any inconvenience that you create for others. 故意做一些会给别人带来不便的事情，可能看起来很无礼。另一方面，随着你继续阅读本节内容，你会发现大多数练习只会给他人带来轻微的不便，而且很多都是人们经常遇到的情境。你通过这些练习可能获得的显著收益，很可能超过你给他人带来的任何不便。
Listed below are some examples of practices that others have found useful for becoming more comfortable with conflict situations: 以下列出了一些其他人发现有助于更自在面对冲突情境的练习示例：
Ask someone else to change his or her behavior. For example, ask your roommate to wash his or her dishes rather than leaving dirty dishes lying around. Or, ask another person to stop talking in a movie theater. 请别人改变他或她的行为。例如，要求你的室友洗碗，而不是把脏碗碟随意放着。或者，要求另一个人在电影院里停止讲话。
Stay stopped in your car for a few seconds when the light turns green. Pretend you are changing the radio station or that you didn’t notice the light turn green. The drivers who are backed up behind you eventually may become frustrated and honk their horns. This should be your signal to drive away. 当红灯变绿时，在车里停几秒钟。假装你正在换电台，或者没注意到灯变绿。后面堵车的司机可能会感到不耐烦并按喇叭。这时应该是你开车离开的信号。
Say no when you don’t want to do something. If someone asks you to do something that you don’t want to do (for example, donate money that you can’t afford, purchase an item from a telemarketer, do more than your fair share of work, and so on), say no in an assertive (though polite) way. Again, we recommend that you read chapter 10 for suggestions regarding assertive communication. 当你不想做某事时，说“不”。如果有人让你做你不想做的事（例如，捐你负担不起的钱，购买电话推销员的商品，做超过你应尽份额的工作等等），请以坚定（但礼貌）的方式说不。我们建议你阅读第 10 章，了解有关坚定沟通的建议。
Return an item to a store. Return a book, an article of clothing, or some other item to a store. In most cases, the staff at the store will gladly take back the item. However, sometimes you may encounter a negative response, which will provide you with the opportunity to get used to this uncomfortable situation. To really test yourself, try to return an item without a receipt, without the original packaging, or after the allowed period for returns has passed. The store may not take back the item, but you will get an opportunity to practice dealing with possible conflict. 将物品退回商店。将书籍、衣物或其他物品退回商店。在大多数情况下，商店的工作人员会乐意接受退货。然而，有时你可能会遇到负面回应，这将为你提供适应这种不舒服情境的机会。为了真正考验自己，试着在没有收据、没有原包装或超过允许退货期限后退货。商店可能不会接受退货，但你将有机会练习应对可能的冲突。
Send food back in a restaurant. Ask your server to take your food back (for instance, to change the dressing on your salad, make your soup hotter, cook your food more thoroughly, or bring you a different drink). 在餐厅退回食物。请服务员把你的食物拿回去（例如，更换沙拉酱，给汤加热，食物煮得更熟一些，或者给你换一杯饮料）。
Take an extra long time at a bank machine when there are people waiting behind you. For example, make several deposits, transfer funds from one 当有人在你后面排队时，在自动取款机前多花点时间。例如，进行多次存款，从一个账户转账资金
account to another, and withdraw cash from two or more different accounts. Make eye contact with others in line to see if they are looking impatient. 从一个账户转账到另一个账户，并从两个或多个不同的账户提取现金。与排队中的其他人进行眼神交流，观察他们是否显得不耐烦。
Forget your money when paying for an item in a store. For example, when you reach the front of a supermarket line, tell the cashier that you have forgotten your wallet. Or, have more items in your cart than you can afford to purchase. This will help you to better tolerate the possibility of inconveniencing the cashier and the people in line behind you. 在商店付款时忘记带钱。例如，当你排到超市收银台前时，告诉收银员你忘带钱包了。或者，购物车里的商品比你能支付的还多。这将帮助你更好地容忍可能给收银员和排在你后面的人带来的不便。
Ask a stranger to stop smoking. If you are in a restaurant or bar, or even in a public place outdoors, try asking the person next to you to stop smoking. Use some discretion. For example, don’t practice this if the other person seems aggressive, likely to get angry, or is much bigger than you are. 请陌生人停止吸烟。如果你在餐厅、酒吧，甚至户外公共场所，试着请你旁边的人停止吸烟。要注意分寸。例如，如果对方看起来很有攻击性、可能会生气，或者体型远大于你，就不要练习这个。
Now, can you think of other possible practices that involve some risk of mild conflict? If so, record them in the space below: 现在，你能想到其他可能涉及轻微冲突风险的练习吗？如果能，请在下面的空白处记录下来：
Other Practices 其他练习
Practices Involving Being the Center of Attention 成为关注中心的练习
Here are some suggestions for ways to draw attention to yourself. If you are afraid of looking foolish, standing out in a crowd, or simply being observed by others, try some of these exercises: 以下是一些吸引别人注意你的建议。如果你害怕看起来愚蠢、在人群中突出，或者仅仅是被别人观察，试试以下练习：
Say something incorrectly. Purposefully answer a question incorrectly in class, provide someone with incorrect information, or mispronounce a word. 故意说错。故意在课堂上回答错误的问题，给别人提供错误的信息，或者把一个词发音错误。
Speak loudly. Speak loudly in a public place (for example, at a mall, in a bus, or on the subway), so that others around you can hear your conversation. 大声说话。在公共场所（例如商场、公交车上或地铁里）大声说话，让周围的人都能听到你的谈话。
Have a mobile phone or pager go off in a public place. Arrange for someone to page you or call you on your cell phone while you are at the dentist, eating at a restaurant, or walking through a public place. Use some discretion here. For example, don’t try this practice during a college exam, a job interview, or while at a movie, unless your intention is to annoy the people around you. 在公共场所让手机或寻呼机响起。安排某人在你去看牙医、在餐厅吃饭或走过公共场所时给你发寻呼或打手机。这里要注意分寸。例如，除非你想惹恼周围的人，否则不要在大学考试、工作面试或看电影时尝试这种做法。
Drop something. Drop your keys, your books, or some other item in a public place. Or, spill water all over your shirt. 掉东西。在公共场所掉落你的钥匙、书本或其他物品。或者，把水洒在你的衬衫上。
Talk about yourself. When speaking with other people, talk about your family, your job, your hobbies, or some other aspect of your personal life. Offer your opinions about political issues, books that you have read recently, or movies that you have seen. 谈论自己。与他人交谈时，谈谈你的家庭、工作、爱好或个人生活的其他方面。发表你对政治问题、最近读过的书或看过的电影的看法。
Participate in a party game. For example, play Twister, Pictionary, Scattergories, Outburst, Trivial Pursuit, or some other game with friends, coworkers, or your family. 参加派对游戏。例如，与朋友、同事或家人一起玩 Twister、Pictionary、Scattergories、Outburst、Trivial Pursuit 或其他游戏。
Wear your shirt or dress inside out or backward. Walk around a public place while making a fashion faux pas. The more outrageous, the better. For example, wear shoes that don’t match. Wear a plaid shirt with striped pants. Wear your dress or shirt inside out (this exercise is even better if your dress or shirt has shoulder pads), or wear a formal evening gown during the day. With practice, you will become much less concerned about looking conspicuous. 穿反或穿反你的衬衫或连衣裙。在公共场所走动时故意穿着不合时宜的服装。越夸张越好。例如，穿不配对的鞋子。穿格子衬衫配条纹裤子。把你的连衣裙或衬衫穿反（如果你的连衣裙或衬衫有肩垫，这个练习效果更佳），或者白天穿正式的晚礼服。通过练习，你会变得不那么在意自己是否显眼。
Knock over a display in a store. For example, knock over a few rolls of paper towels or toilet paper in the supermarket. Again, it is important to use good judgment. For example, don’t knock over glass jars of tomato sauce. That would be going too far! 在商店里撞倒一个陈列架。例如，在超市里撞倒几卷纸巾或卫生纸。同样，使用良好的判断力很重要。例如，不要撞倒装有番茄酱的玻璃罐。这就太过分了！
Now, can you think of other possible practices that involve being the center of attention? If so, record them in the space below: 现在，你能想到其他可能让自己成为关注中心的练习吗？如果能，请在下面的空白处记录下来：
Other Practices 其他练习
Practices Involving Eating or Drinking with Others 与他人一起吃喝的练习
People who fear drinking in front of others are often concerned about having shaky hands and spilling their drinks. Those who are fearful of eating in front of others may be nervous about making a mess, looking unattractive while eating, or feeling flushed from eating hot foods. You should choose to practice exposure in situations that will challenge your specific anxieties. For example, if you are more anxious when eating messy foods, you should order foods that are more likely to be messy. If you’re nervous about blushing or sweating, order hot soup or a spicy meal. A list of situations offering an opportunity to eat or drink in front of others is provided here: 害怕在别人面前喝东西的人通常担心手抖而洒出饮料。害怕在别人面前吃东西的人可能会紧张自己弄得一团糟、吃相难看，或者因为吃热食而脸红。你应该选择在能够挑战你特定焦虑的情境中进行暴露练习。例如，如果你在吃容易弄脏的食物时更焦虑，就应该点更容易弄脏的食物。如果你担心脸红或出汗，可以点热汤或辣味餐。这里提供了一些在别人面前吃喝的情境列表：
Eat a snack at your desk. If your desk at work is in an open area, eat a snack at your desk. This may be easier than eating with your coworkers. When this exercise becomes easier, you can move to other practices, such as those in the rest of this list. 在办公桌上吃零食。如果你工作的办公桌位于开放区域，可以在办公桌上吃零食。这可能比和同事一起吃更容易。当这个练习变得容易后，你可以尝试列表中其他的练习。
Hold a drink at a party or gathering. If you tend to be anxious when holding a glass of wine or a soft drink in front of others, try doing just that the next time you’re at a party or other social gathering. Try not to hide your hands if they begin to shake. If alcohol tends to decrease your anxiety, make sure you don’t drink wine, beer, or spirits until after your anxiety has decreased on its own. 在聚会或集会中手持饮料。如果你在别人面前拿着一杯葡萄酒或软饮时容易感到焦虑，下次参加聚会或其他社交活动时，试着这样做。如果手开始发抖，尽量不要掩盖。若酒精能减轻你的焦虑，确保在焦虑自然减轻之前不要饮用葡萄酒、啤酒或烈酒。
Have lunch with coworkers. You probably eat lunch every day. You might as well eat with other people, if the opportunity arises. If your natural tendency is to eat at your desk or to eat lunch in restaurants alone, invite a coworker to join you for lunch once or twice every week. 与同事共进午餐。你可能每天都吃午饭。如果有机会，不妨和别人一起吃。如果你习惯在办公桌前吃饭或独自去餐厅吃午餐，每周邀请一两次同事一起吃午饭。
Meet a friend at a restaurant for dinner. If you tend to feel safer in dark restaurants, challenge yourself by choosing a more brightly lit location. Try to choose a seat where you are more likely to be observed by the other people in the restaurant. 与朋友在餐厅共进晚餐。如果你倾向于在昏暗的餐厅感到更安全，挑战自己选择一个光线更明亮的地方。尽量选择一个更容易被餐厅其他人观察到的座位。
Invite people over for a meal. For example, invite two or three friends or neighbors over for dinner. 邀请人们来家里吃饭。例如，邀请两三位朋友或邻居来家里吃晚饭。
Dine at other people’s homes. If you tend to decline invitations to eat at other people’s homes, accept the invitation next time. You may find it more difficult to do so if you are concerned about not being able to control the environment (such as the lighting), who the other guests are, and what types of food are served, but don’t use these as reasons to avoid the situation. 在别人家里用餐。如果你倾向于拒绝去别人家吃饭的邀请，下次请接受邀请。如果你担心无法控制环境（比如灯光）、其他客人是谁以及提供什么类型的食物，可能会觉得更难做到，但不要以这些理由来回避这种情况。
Dine alone in a restaurant, food court, or another public place. If eating alone in public makes you anxious, having lunch alone in a restaurant or food court is an appropriate practice. You might also want to consider eating in other public places, such as sitting on a bench in a park or in a shopping mall. 独自在餐厅、美食广场或其他公共场所用餐。如果独自在公共场所吃饭让你感到焦虑，那么在餐厅或美食广场独自吃午饭是一个合适的练习。你也可以考虑在其他公共场所用餐，比如坐在公园的长椅上或购物中心里。
Can you think of other possible practices that involve eating or drinking in front of others? If so, record them in the space below: 你能想到其他涉及在别人面前吃喝的练习吗？如果有，请在下面的空白处记录：
Other Practices 其他练习
Practices Involving Writing in Front of Others 在他人面前写作的练习
As a rule, people who are uncomfortable writing in front of others are concerned about having shaky hands while they are writing. They also may be fearful of others judging their handwriting or noticing personal information that they may be recording. Examples of situations that can provide an opportunity to write in front of others include the following: 通常情况下，不愿意在他人面前写作的人担心写字时手会发抖。他们也可能害怕别人评判他们的笔迹，或者注意到他们可能正在记录的个人信息。以下是一些可以提供在他人面前写作机会的情境示例：
Pay for items using a check. Instead of paying with cash or a debit card, write a check when purchasing merchandise in a store. Be sure to complete the check in front of the cashier (don’t write out the check before you get to the store: that’s cheating). If you’re concerned about having the cashier notice your shaky hands, try making your hands shake purposefully. In fact, to really challenge your fear, let your hands shake so much that you have to write a whole new check. 使用支票付款。购买商店商品时，不用现金或借记卡付款，而是写支票。务必在收银员面前填写支票（不要在到店之前就写好支票：那样算作弊）。如果你担心收银员会注意到你手抖，可以尝试故意让手抖。实际上，为了真正挑战你的恐惧，可以让手抖得厉害到需要重新写一张支票。
Write a letter while seated in a public place. Write a letter to a friend while sitting in a café, riding on a bus, or relaxing on a public bench. Make sure that there are others around who can see you writing. 在公共场所坐着写信。在咖啡馆、公交车上或公共长椅上放松时，给朋友写信。确保周围有人能看到你在写字。
Fill out forms or applications in front of other people. For example, complete an application for a new credit card or loan at a bank (with the bank officer watching), complete an application for a new video-store membership, fill out a contest ballot in front of a cashier, or sign documents in front of your coworkers. 在别人面前填写表格或申请。例如，在银行（银行职员在旁观看）填写新的信用卡或贷款申请，填写新的视频店会员申请，在收银员面前填写比赛投票表，或在同事面前签署文件。
Can you think of other possible practices that involve writing in front of other people? If so, record them in the space below: 你能想到其他需要在别人面前书写的练习吗？如果有，请在下面的空白处记录：
Other Practices 其他练习
Practices Involving Job Interviews 涉及求职面试的练习
To become more comfortable with job interviews, the best exposure practices are those that provide experiences similar to real job interviews. Some examples include: 为了让自己在求职面试中更加自如，最有效的暴露练习是那些提供类似真实求职面试体验的练习。一些例子包括：
Apply for a volunteer position. Many volunteer opportunities (for example, in hospitals, schools, theater companies, charitable organizations, community 申请志愿者职位。许多志愿者机会（例如，在医院、学校、剧团、慈善组织、社区机构等）都以一个非常类似于有偿工作的面试过程开始。
agencies, and so on) begin with an interview process that is very similar to an interview for a paying job. You may feel less pressure if you know that you’re applying for a nonpaying position. If so, this would be a good place to start. In addition to giving the employer the opportunity to meet you, another purpose of an interview is to give you a chance to evaluate the position. Applying for a volunteer position does not commit you to accepting it if it’s offered. If you decide it isn’t for you, you can always turn it down. If you apply for several volunteer jobs, you will become more comfortable with the entire interview process. 如果你知道自己申请的是无偿职位，可能会感到压力较小。如果是这样，这将是一个很好的起点。除了让雇主有机会了解你之外，面试的另一个目的也是让你有机会评估该职位。申请志愿者职位并不意味着你必须接受该职位的邀请。如果你觉得不适合自己，可以随时拒绝。如果你申请多个志愿者职位，你将会对整个面试过程变得更加熟悉和自信。
Practice interviews with family members or friends. Practicing job interviews with friends or family members is another good way to begin the process of overcoming anxiety over job interviews. You will need to coach your friend or family member about the nature of the interview and the role that he or she should take. You may also want to work up to having some of these role-play interviews become particularly challenging (for example, have your helper play the role of a hostile interviewer), so you can learn to be more comfortable with difficult interviews in real life. 与家人或朋友进行模拟面试。与朋友或家人练习求职面试是开始克服面试焦虑的另一种好方法。你需要向你的朋友或家人说明面试的性质以及他们应扮演的角色。你也可以逐步让这些角色扮演的面试变得更具挑战性（例如，让你的帮手扮演一个敌对的面试官），这样你就能学会在现实生活中更从容地应对困难的面试。
Apply for jobs that are not particularly interesting to you. A great way of learning to overcome a fear of job interviews is to practice interviewing for jobs that are not high on your list. You might as well learn how to interview more effectively in situations in which you have little to lose. By practicing interviewing for jobs you don’t particularly want, you will be better prepared when it comes time to interview for a job that interests you. 申请那些你并不特别感兴趣的工作。克服求职面试恐惧的一个好方法是练习面试那些你并不太想要的工作。你不妨在几乎没有损失的情况下学习如何更有效地面试。通过练习面试那些你并不特别想要的工作，当你真正面试自己感兴趣的工作时，你会准备得更充分。
Apply for jobs that interest you. If you are looking for a new job, eventually you must be able to interview for the job you want. The more jobs you apply for, the more interviews you will be offered. The more interviews that you get, the more opportunities you will have to practice your interviewing skills and to overcome your fear of being interviewed. Although it’s reasonable to start the process by interviewing for jobs that are not particularly interesting to you, you should also be applying for jobs that you might really be interested in accepting. 申请你感兴趣的工作。如果你正在寻找新工作，最终你必须能够面试你想要的职位。你申请的工作越多，获得的面试机会就越多。面试机会越多，你就有更多机会练习面试技巧，克服对面试的恐惧。虽然从面试那些你并不特别感兴趣的工作开始是合理的，但你也应该申请那些你可能真正有兴趣接受的工作。
Can you think of other possible practices that involve interviewing for a job? If so, record them in the space below: 你能想到其他可能涉及面试工作的练习吗？如果能，请在下面的空白处记录下来：
Other Practices 其他练习
Practices Involving Being in Public 涉及公开场合的练习
For some people, just being around other people is anxiety provoking, even if there is no interaction or direct social contact. If being in a public place is difficult for you, here are some examples of public places where you may be able to practice exposure. Remember to practice frequently and to stay long enough for your fear to decrease. If you must leave the situation, try to return to it as soon as possible. 对于有些人来说，仅仅是与他人同处一室就会引发焦虑，即使没有互动或直接的社交接触。如果你觉得在公共场所很困难，以下是一些你可以练习暴露的公共场所示例。记住要经常练习，并且停留足够长的时间，直到你的恐惧减轻。如果你必须离开现场，尽量尽快返回。
Go to a mall or supermarket. Shopping is a good way of exposing yourself to other people in a public place. Try shopping when the stores are more crowded to challenge your fearful thoughts even more. 去商场或超市。购物是让自己暴露在公共场所他人面前的好方法。尝试在人多的时候购物，以更好地挑战你的恐惧想法。
Make eye contact in a public place. If appropriate, make eye contact with other people while you walk down the street or while sitting on a bus or subway. Of course, for safety reasons, this may not be wise in some cities, particularly at night, or in dangerous parts of town. 在公共场所进行眼神交流。如果合适的话，走在街上或坐公交车、地铁时与他人进行眼神交流。当然，出于安全考虑，在某些城市，尤其是夜晚或危险地区，这样做可能不明智。
Go to a concert or sporting event. A guaranteed place to encounter lots of other people is at a large concert, sporting event, movie theater, or other entertainment venue. If you prefer to sit in an aisle seat or near the exit (for a quick escape), try sitting in the middle of the row and away from the exit. 去参加音乐会或体育赛事。大型音乐会、体育赛事、电影院或其他娱乐场所是遇到许多人的绝佳场所。如果你喜欢坐在过道座位或靠近出口（方便快速离开），试着坐在排中间且远离出口的位置。
Read in a public place. Spend some time reading your favorite book, a newspaper, or a new novel at a coffee shop or library. 在公共场所阅读。在咖啡馆或图书馆花些时间阅读你喜欢的书籍、报纸或新小说。
Join a gym or take an aerobics class. Rather than exercising alone, practice exercising in front of others. For example, join an aerobics class and take a spot near the front of the room. Or, lift weights near other people who are more experienced and stronger than you are. 加入健身房或参加有氧运动课程。不要独自锻炼，尝试在别人面前锻炼。例如，参加有氧运动课程，选择靠近教室前方的位置。或者，在比你更有经验、更强壮的人附近举重。
Can you think of other possible practices that involve being in public? If so, record them in the space below: 你能想到其他涉及在公共场合的练习吗？如果有，请在下面的空白处记录：
Other Practices 其他练习
Practices Involving Speaking to Authority Figures 涉及与权威人物交谈的练习
Going out of your way to make contact with people in authority who make you feel uncomfortable is an effective way to learn how to be more comfortable with authority 特意去接触那些让你感到不舒服的权威人物，是学习如何更自在地面对权威的有效方法。
figures. Examples of relevant exposure practices are listed below. If any of these are situations in which you would like to feel more comfortable, they may be appropriate practices for you to try. 以下列出了一些相关的暴露练习示例。如果这些情境中有你希望感到更自在的，可能适合你尝试这些练习。
Have a meeting with your boss or teacher. If you are a student, ask your teacher to meet with you to discuss a difficult homework assignment. If you are working, ask your boss for an appointment to discuss your performance or some other aspect of your job. 与您的老板或老师开会。如果您是学生，可以请老师与您见面，讨论一项困难的作业。如果您正在工作，可以请老板安排一个时间，讨论您的工作表现或工作的其他方面。
Ask a pharmacist questions about a medication. If you are taking any medications, ask a pharmacist to answer particular questions about the medication (for example, side effects, interactions with other medications, how to get refills, and so on). If you’re not taking any medications, you can still ask questions, perhaps on behalf of a friend or family member. 向药剂师提问有关药物的问题。如果您正在服用任何药物，可以请药剂师回答有关该药物的具体问题（例如副作用、与其他药物的相互作用、如何续药等）。如果您没有服用任何药物，也可以提问，或许是代表朋友或家人。
Ask your doctor to explain a particular medical issue. Make an appointment with your family doctor to ask questions about symptoms that you may be experiencing. Be sure to have your questions answered. 请医生解释某个具体的医疗问题。预约家庭医生，询问您可能正在经历的症状。确保您的问题得到解答。
Meet with your bank manager. For example, arrange to meet with your bank’s manager or loan officer to discuss the possibility of obtaining a loan or mortgage. 与您的银行经理会面。例如，安排与银行经理或贷款专员见面，讨论获得贷款或抵押贷款的可能性。
Meet with a lawyer. For example, meet with a lawyer to discuss estate planning (writing a will) or some other legal issue that you are dealing with. 与律师会面。例如，与律师会面讨论遗产规划（写遗嘱）或您正在处理的其他法律问题。
Meet with an accountant or financial advisor. Hire an accountant with whom you feel intimidated to do your taxes, or meet with an intimidating financial advisor to get investment advice. 与会计师或理财顾问会面。聘请一位让您感到害怕的会计师来帮您报税，或者与一位令您感到害怕的理财顾问会面，获取投资建议。
Can you think of other possible practices that involve interacting with people in authority? If so, record them in the space below: 您能想到其他涉及与权威人士互动的练习吗？如果有，请在下面的空白处记录：
Other Practices 其他练习
CHALLENGING YOUR WORST FEARS 挑战你最深的恐惧
By repeatedly exposing yourself to anxiety-provoking situations, you will continue to challenge most of your deeply held beliefs and predictions concerning your ability 通过反复让自己暴露在引发焦虑的情境中，你将不断挑战自己关于应对社交和表现情境能力的许多根深蒂固的信念和预测。
to cope with social and performance situations. Ideally, exposure practices should be designed to test the validity of your anxious assumptions. For example, if you are fearful of saying something foolish during a conversation at a party, it’s not enough simply to attend parties, although just attending may be a reasonable first step. To more thoroughly challenge such an anxiety-provoking belief, you also would need to talk to other people at the party. By having numerous conversations with others, eventually you will learn that most of what you say is not foolish at all. 理想情况下，暴露练习应设计为检验你焦虑假设的有效性。例如，如果你害怕在聚会上说出愚蠢的话，仅仅参加聚会是不够的，尽管参加聚会可能是一个合理的第一步。为了更彻底地挑战这种引发焦虑的信念，你还需要与聚会上的其他人交谈。通过与他人进行多次对话，最终你会发现自己说的大多数话根本不愚蠢。
After reaching a certain level of comfort talking to other people at parties, the next step might be to practice saying something silly or foolish purposefully and to evaluate the consequences. This exercise would help to challenge your anxious beliefs at an even deeper level. Chances are that even if you did say something foolish at a party, the consequences would be minimal. With this type of exposure practice, you would learn not only that you can engage in effective conversations with others, but that even if you make a mistake from time to time, it doesn’t really matter. 在派对上与他人交谈达到一定的舒适度后，下一步可能是有意识地说一些傻话或愚蠢的话，并评估其后果。这个练习有助于更深层次地挑战你的焦虑信念。很可能即使你在派对上说了些傻话，后果也会很小。通过这种暴露练习，你不仅会学会与他人进行有效的交流，还会明白即使偶尔犯错，也没什么大不了的。
The strategies discussed in this section are useful for increasing the intensity of your exposure practices by testing out the validity of your “What if?” thoughts. Rather than dwelling on questions like “What if I make a mistake?” or “What if I draw attention to myself?” we suggest that you try to answer these questions by purposefully making a mistake or purposefully drawing attention to your behavior. In all likelihood, you will discover that nothing terrible happens. 本节讨论的策略有助于通过检验你“如果……会怎样？”想法的真实性，来增加暴露练习的强度。我们建议你不要纠结于“如果我犯错怎么办？”或“如果我引起别人的注意怎么办？”这样的问题，而是尝试通过有意识地犯错或有意识地吸引别人注意你的行为来回答这些问题。很可能你会发现并没有什么可怕的事情发生。
Purposefully Making Mistakes or Trying to Look Stupid 有意识地犯错或试图显得愚蠢
When you have begun feeling more comfortable in some of your feared situations, a reasonable next step is to make some small mistakes purposefully, or to do things that make you look foolish or stupid. Examples of this kind of purposeful behavior include pronouncing a word incorrectly while speaking to your boss, asking an obvious question in class, or bumping into a door. There is no need to make big mistakes (for example, purposefully failing an exam or crashing your car). Small mistakes will work just fine, and the consequences will be minimal. 当你开始在一些令你害怕的情境中感到更加自在时，一个合理的下一步是故意犯一些小错误，或者做一些让自己看起来愚蠢或傻气的事情。这类故意行为的例子包括在和老板说话时把一个词发音错误，在课堂上问一个明显的问题，或者撞到门。没有必要犯大错误（例如，故意考试不及格或撞车）。小错误就足够了，且后果会很小。
Purposefully Drawing Attention to Yourself 故意吸引别人的注意
If being the center of attention is difficult for you, your exposure practices should include attempts to draw the attention of others to your behavior. For example, rather than arriving early or on time for a movie or a class, try arriving a few minutes late, so that everyone is aware of you when you enter the room. You may feel embarrassed momentarily, but you will learn from the practice that the whole experience doesn’t matter, even minutes later. Your embarrassment will be temporary. Also, people probably will forget about your late arrival almost instantly and soon will be thinking about other things. 如果成为关注的焦点对你来说很困难，那么你的暴露练习应包括试图吸引他人注意你的行为。例如，与其提前或准时到达电影或课堂，不如尝试晚几分钟到达，这样当你进入房间时，所有人都会注意到你。你可能会感到一时尴尬，但通过这种练习你会学到，整个经历并不重要，甚至几分钟后就无关紧要了。你的尴尬感是暂时的。此外，人们很可能几乎立刻就会忘记你迟到的事，很快就会转而关注其他事情。
Purposefully Increasing Your Anxiety Symptoms 有意识地增加你的焦虑症状
In addition to entering the situations you fear, a more complete test of your anxietyprovoking beliefs is to deliberately arouse some of the symptoms that frighten you in social or performance situations. Chapter 9 discusses these strategies in some detail. Some examples of possible exposure exercises include the following: wetting your forehead (to simulate sweating) before giving a presentation, purposefully appearing to lose your train of thought during a meeting or presentation, and purposefully allowing your hands to shake while writing or holding a drink. By deliberately bringing on the symptoms you fear (in a predictable and controlled way), you will learn to be less frightened of having these symptoms show in front of others. 除了记录你害怕的情境外，更全面地测试你引发焦虑的信念的方法是故意激发一些在社交或表现场合中令你害怕的症状。第 9 章详细讨论了这些策略。一些可能的暴露练习示例包括：在做演讲前弄湿额头（模拟出汗）、故意在会议或演讲中表现出思路中断、故意让双手在写字或拿饮料时颤抖。通过以可预测且可控的方式故意引发你害怕的症状，你将学会不那么害怕在他人面前表现出这些症状。
Expressing Personal Opinions 表达个人观点
Finally, if you are afraid to express personal opinions during a conversation, just engaging in conversations, without expressing personal opinions, will not be enough to test the validity of your fearful beliefs. Conversation alone will not teach you that your fears are unfounded. Instead, you should make sure that you express your feelings or opinions during your exposure practices. 最后，如果你害怕在对话中表达个人观点，仅仅参与对话而不表达个人观点，无法检验你恐惧信念的真实性。单纯的对话不会让你明白你的恐惧是没有根据的。相反，你应确保在暴露练习中表达你的感受或观点。
DEVELOPING A SITUATIONAL EXPOSURE HIERARCHY 制定情境暴露层级
Before beginning exposure therapy, it is helpful to generate a list of very specific situations that range in difficulty from mildly to extremely anxiety-producing. This list of situations, called a situational exposure bierarchy, will help to guide your exposure practices. 在开始暴露疗法之前，列出一份非常具体的情境清单是有帮助的，这些情境的难度从轻微到极度引发焦虑不等。这份情境清单，称为情境暴露层级，将帮助指导你的暴露练习。
Usually, the situations on the hierarchy include details that take into account particular themes that contribute to how much fear you are likely to experience. These themes may include the size of the group or audience (for example, it may be easier to talk to one person than five people; five people may be easier to handle than fifty), the length of time involved (for instance, a five-minute conversation vs. a thirty-minute conversation), your relationship with the other person (for example, a family member vs. a stranger), and so on. 通常，层级中的情境会包含考虑到特定主题的细节，这些主题会影响你可能经历的恐惧程度。这些主题可能包括群体或观众的规模（例如，与一个人交谈可能比与五个人交谈更容易；五个人可能比五十个人更容易应对）、涉及的时间长度（例如，五分钟的对话与三十分钟的对话）、你与对方的关系（例如，家庭成员与陌生人）等等。
Two examples of situational exposure hierarchies follow. The first hierarchy is for a person with the fear of public speaking, and the second is for someone who experiences social anxiety in many different situations (in other words, generalized social anxiety). Note that the hierarchy items are very specific with respect to the duration of the practice, the types of people present, and other relevant variables. Developing specific items is important because it’s difficult to develop practices based on overly vague hierarchy items. Fear and avoidance ratings are based on a scale ranging from 0 (no fear, no avoidance) to 100 (maximum fear, complete avoidance). 以下是两个情境暴露层级的示例。第一个层级适用于害怕公开演讲的人，第二个层级适用于在多种不同情境中经历社交焦虑的人（换句话说，广泛性社交焦虑）。请注意，层级条目在练习持续时间、在场人员类型及其他相关变量方面都非常具体。制定具体条目很重要，因为基于过于模糊的层级条目很难设计练习。恐惧和回避评分基于一个从 0（无恐惧，无回避）到 100（极度恐惧，完全回避）的量表。
Sample Situational Exposure Hierarchy: Public Speaking 情境暴露层级示例：公开演讲
Situation 情境
Fear 恐惧
Avoidance 回避
1. Give a 1 -hour, formal lecture to 200 strangers about a topic that I don't know well. 1. 向 200 个陌生人做一个小时的正式讲座，讲一个我不太熟悉的主题。
100
100
2. Give a 1 -hour, formal lecture to 30 strangers about a topic that I don't know well. 2. 向 30 个陌生人做一个小时的正式讲座，讲一个我不太熟悉的主题。
99
100
3. Give a 1 -hour, formal lecture to 200 strangers about a familiar topic. 3. 向 200 个陌生人做一个小时的正式讲座，讲一个熟悉的主题。
90
100
4. Give a 1-hour, formal lecture to 30 strangers about a familiar topic. 4. 向 30 个陌生人做一个小时的正式讲座，主题是熟悉的话题。
85
100
5. Give a 1 -hour, informal presentation to 20 coworkers about an unfamiliar topic. 5. 向 20 个同事做一个小时的非正式演讲，主题是不熟悉的话题。
85
90
6. Give a 1 -hour, informal presentation to 20 coworkers about a familiar topic. 6. 向 20 个同事做一个小时的非正式演讲，主题是熟悉的话题。
70
70
7. Give a 1 -hour, informal presentation to 20 young children about my work. 7. 向 20 个小朋友做一个小时的非正式演讲，内容是关于我的工作。
65
65
8. Make comments or ask questions in a large meeting (more than 15 people). 8. 在大型会议（超过 15 人）中发表评论或提问。
50
60
9. Make comments or ask questions in a small meeting (5 or 6 people). 9. 在小型会议（5 或 6 人）中发表评论或提问。
40
40
10. Offer to make a toast at a family dinner. 10. 在家庭聚餐时主动提出敬酒。
35
35
Situation Fear Avoidance
1. Give a 1 -hour, formal lecture to 200 strangers about a topic that I don't know well. 100 100
2. Give a 1 -hour, formal lecture to 30 strangers about a topic that I don't know well. 99 100
3. Give a 1 -hour, formal lecture to 200 strangers about a familiar topic. 90 100
4. Give a 1-hour, formal lecture to 30 strangers about a familiar topic. 85 100
5. Give a 1 -hour, informal presentation to 20 coworkers about an unfamiliar topic. 85 90
6. Give a 1 -hour, informal presentation to 20 coworkers about a familiar topic. 70 70
7. Give a 1 -hour, informal presentation to 20 young children about my work. 65 65
8. Make comments or ask questions in a large meeting (more than 15 people). 50 60
9. Make comments or ask questions in a small meeting (5 or 6 people). 40 40
10. Offer to make a toast at a family dinner. 35 35| Situation | Fear | Avoidance |
| :--- | :--- | :--- |
| 1. Give a 1 -hour, formal lecture to 200 strangers about a topic that I don't know well. | 100 | 100 |
| 2. Give a 1 -hour, formal lecture to 30 strangers about a topic that I don't know well. | 99 | 100 |
| 3. Give a 1 -hour, formal lecture to 200 strangers about a familiar topic. | 90 | 100 |
| 4. Give a 1-hour, formal lecture to 30 strangers about a familiar topic. | 85 | 100 |
| 5. Give a 1 -hour, informal presentation to 20 coworkers about an unfamiliar topic. | 85 | 90 |
| 6. Give a 1 -hour, informal presentation to 20 coworkers about a familiar topic. | 70 | 70 |
| 7. Give a 1 -hour, informal presentation to 20 young children about my work. | 65 | 65 |
| 8. Make comments or ask questions in a large meeting (more than 15 people). | 50 | 60 |
| 9. Make comments or ask questions in a small meeting (5 or 6 people). | 40 | 40 |
| 10. Offer to make a toast at a family dinner. | 35 | 35 |
Sample Situational Exposure Hierarchy: Generalized Social Anxiety 情境暴露层级示例：广泛性社交焦虑
Situation Fear Avoidance 情境 恐惧 避免
Give a 1 -hour, formal lecture to 30 coworkers about a … 100 … 100 familiar topic. 给 30 位同事做一个 1 小时的正式讲座，主题是一个……100……100 熟悉的话题。
Have a party at my home for my coworkers. … 95 … 95 在我家为同事举办一个聚会……95……95
Ask Pat out for a dinner date. … 90 … 100 邀请 Pat 共进晚餐约会……90……100
Answer a personal ad in the newspaper. … 85 … 100 回复报纸上的个人广告。… 85 … 100
Attend the annual holiday party at work without drinking … 85 alcohol. … 85 参加公司年度假日聚会且不喝酒。… 85 … 85
Attend a tea for a coworker who is retiring. … 70 … 70 参加为即将退休的同事举办的茶话会。… 70 … 70
Have a formal dinner with Rita (a friend). … 70 … 75 与朋友丽塔共进正式晚餐。… 70 … 75
Talk about personal feelings or opinions with my … 60 coworkers. 和我的……60 位同事谈论个人感受或意见。
Have a fast-food lunch with Rita. … 60 … 50 和丽塔一起吃快餐午餐。……60……50
Have a conversation with the person sitting next to me on … 50 … 50 a bus. 和坐在我旁边的公交车上的人交谈。……50……50
Ask someone for directions or for the time. … 45 … 45 向某人问路或问时间。……45……45
Call Rita on the telephone. … 40 … 40 给丽塔打电话。… 40 … 40
Eat alone in a crowded food court at the mall. … 40 … 40 在拥挤的商场美食广场独自用餐。… 40 … 40
Walk around at a crowded mall. … 35 … 35 在拥挤的商场里走动。… 35 … 35
Answer the telephone without checking my caller ID. … 30 … 30 接电话时不查看来电显示。… 30 … 30
To generate your own hierarchy, refer back to the suggested exposure practices in this chapter as well as to the results of your self-assessment in chapter 3. Choose situations that range in difficulty from slightly anxiety-provoking to completely overwhelming. 要生成你自己的层级列表，请参考本章中建议的暴露练习以及第 3 章中你的自我评估结果。选择难度从轻微引发焦虑到完全压倒性的情境。
Record these situations in order of difficulty (starting with the most anxiety-provoking at the top) in the spaces provided on the following blank Situational Exposure Hierarchy Form. Next, rate each situation to describe the level of fear you would feel if you were in that situation right now (use any number from 0 to 100 , where 0=0= no fear; 25=25= mild fear; 50=50= moderate fear; 75=75= intense fear; and 100=100= very intense fear). Finally, using a 0 - to 100 -point scale, indicate how much you would tend to avoid each situation on your hierarchy ( 0=0= do not avoid the situation; 25=25= hesitate to enter situation, but rarely avoid it; 50=50= sometimes avoid the situation; 75=75= usually avoid the situation; 100=100= always avoid the situation). 将这些情境按难度顺序记录（从最引发焦虑的情境开始，排在最上方），填写在以下空白的情境暴露层级表格中。接着，评估每个情境，描述如果你现在处于该情境中会感受到的恐惧程度（使用 0 到 100 的任意数字，其中 0=0= 表示无恐惧； 25=25= 轻度恐惧； 50=50= 中度恐惧； 75=75= 强烈恐惧； 100=100= 非常强烈的恐惧）。最后，使用 0 到 100 分的量表，标明你在层级中每个情境的回避倾向（ 0=0= 不回避该情境； 25=25= 犹豫进入情境，但很少回避； 50=50= 有时回避该情境； 75=75= 通常回避该情境； 100=100= 总是回避该情境）。
The Shyness & Social Anxiety Workbook 害羞与社交焦虑工作手册
Situational Exposure Hierarchy Form 情境暴露层级表格
Situation 情境
Fear 恐惧
Avoidance 回避
(0-100)(0-100)
(0-100)(0-100)
Fear Avoidance
(0-100) (0-100)| Fear | Avoidance |
| :---: | :---: |
| $(0-100)$ | $(0-100)$ |
Whenever possible, in vivo exposure (actual exposure to feared situations) is preferable to exposure in the imagination. In fact, imagined exposure is rarely used for treating social anxiety. Still, exposure in the imagination may be useful either when the real situation is too overwhelming for you to enter or when you are unable to confront the actual situation for practical reasons (for instance, you have an upcoming college exam and no earlier opportunities to practice taking it). 只要可能，现场暴露（实际接触害怕的情境）优于想象中的暴露。事实上，想象中的暴露很少用于治疗社交焦虑。不过，当真实情境对你来说过于压倒性而无法进入，或者由于实际原因无法面对真实情境时（例如，你有即将到来的大学考试且没有提前练习的机会），想象中的暴露可能会有帮助。
Imagined exposure may be helpful to prepare you to enter the actual situation. When you are using imagined exposure, the guidelines are generally the same as for in vivo exposure. For example, practices should be frequent (if possible, daily) and should continue until your fear decreases (for example, thirty to sixty minutes). Whenever possible, imagined exposure should be followed by in vivo exposure in the actual situation. 想象中的暴露有助于你为进入真实情境做准备。在使用想象暴露时，指导原则通常与现场暴露相同。例如，练习应频繁进行（如果可能，每天进行），并应持续直到你的恐惧减轻（例如，三十到六十分钟）。只要可能，想象中的暴露应随后进行真实情境中的现场暴露。
When conducting imagined exposure practices, close your eyes and try to imagine the situation as vividly as possible. Some people find it helpful to make a tape recording describing the situation in detail and then listen to the tape during subsequent practices. Other people find it helpful simply to imagine being in the situation, without the help of a recorded description. Either way, it’s important to imagine the experience vividly, so that it feels as real as possible. Your imagined exposure practices should produce many of the same feelings that are produced by real exposure, although the intensity of these feelings may be lower during imagined exposure. We recommend that you ask yourself the following questions to help bring the experience to life: 在进行想象暴露练习时，闭上眼睛，尽量生动地想象情境。有些人发现制作一段详细描述情境的录音带，然后在后续练习中听这段录音会很有帮助。另一些人则觉得仅凭想象自己处于该情境中，而不借助录音描述更有效。无论哪种方式，重要的是要生动地想象体验，使其尽可能真实。你的想象暴露练习应产生许多与真实暴露相同的感受，尽管这些感受在想象暴露中可能强度较低。我们建议你问自己以下问题，以帮助使体验更加生动：
What do I see around me? What do my surroundings look like? Who else is here? 我周围看到了什么？我的环境是什么样的？还有谁在这里？
What is happening in this situation? 这个情境中发生了什么？
What emotions am I feeling? 我感受到什么情绪？
What thoughts am I thinking? 我在想什么？
What physical sensations am I experiencing? How intense are they? 我正在经历什么身体感觉？它们有多强烈？
What is my environment like? Is it hot? Humid? 我的环境是怎样的？是热吗？潮湿吗？
What am I doing while in this situation? 我在这种情况下正在做什么？
What sounds am I hearing? 我听到了什么声音？
What odors am I sensing? 我闻到了什么气味？
SITUATIONAL ROLE-PLAY 情境角色扮演
A situational role-play is an exposure practice in which you rehearse being in a simulated social situation before actually entering the real situation. Role-play can provide you with exposure practice without creating the same social risks that are sometimes present in the actual situation. In other words, you have less to lose during simulated exposures, compared with real-life exposures. Below are some examples of how to use situational role-plays to improve your level of comfort, as well as to improve your skills for dealing with particular social situations: 情境角色扮演是一种暴露练习，你在实际进入真实情境之前，先在模拟的社交情境中进行排练。角色扮演可以让你进行暴露练习，同时避免真实情境中有时会出现的社交风险。换句话说，与现实生活中的暴露相比，模拟暴露时你失去的东西更少。以下是一些如何利用情境角色扮演来提升舒适度以及应对特定社交情境技巧的示例：
Before giving a formal presentation at work, practice giving your talk to several friends and relatives. Ask your simulated audience for feedback. If possible, repeat this role-play practice several times. 在工作中正式做演讲之前，先练习向几位朋友和亲戚讲述你的演讲内容。请你的模拟听众给予反馈。如果可能，重复进行这种角色扮演练习几次。
If you’re nervous about making small talk with strangers at parties, ask your partner (or any close friend or relative) to pretend to be an unfamiliar person. Imagine that you have both arrived early for a party and are waiting in the living room while the host prepares food in the kitchen. Practice engaging in small talk, as if you have just met for the first time. 如果你在派对上与陌生人闲聊时感到紧张，可以请你的伴侣（或任何亲密的朋友或亲戚）假装成一个陌生人。想象你们俩都早早到达了派对，正在客厅等待，而主人正在厨房准备食物。练习进行闲聊，就像你们是第一次见面一样。
If you have an upcoming job interview, you can prepare by having friends or relatives simulate interviewing you for a job. 如果你即将参加工作面试，可以让朋友或亲戚模拟面试官来面试你，以此做准备。
In order to practice asking another individual out on a date, you could rehearse what you might say with a close friend or relative. 为了练习邀请别人约会，你可以和亲密的朋友或亲戚排练你可能会说的话。
In the spaces below, record several more simulated exposure role-plays you could use to begin confronting the situations that you fear: 在下面的空白处，记录几个你可以用来开始面对你害怕情境的模拟暴露角色扮演：
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USING EXPOSURE RECORDS AND DIARIES 使用暴露记录和日记
Keeping good records during exposure practices will help you to monitor your progress over time. The Exposure Monitoring Form at the end of this chapter is an example of a diary that can be used to record your experiences during exposure practices. In addition, this form is designed to help you challenge your anxious thoughts during exposure practices. Note that although the Exposure Monitoring Form may seem somewhat complex at first, with practice it will become easier to complete. 在暴露练习过程中保持良好的记录将帮助你随着时间监测自己的进展。本章末尾的暴露监测表是一个可以用来记录你在暴露练习中经历的日记示例。此外，该表格旨在帮助你在暴露练习中挑战你的焦虑想法。请注意，虽然暴露监测表起初可能看起来有些复杂，但通过练习，填写起来会变得更容易。
At the top of the form, you should describe the particular situation that you’re practicing; the date, time, and duration of the practice; and your fear level before and after the practice (use a 0 - to 100 -point scale, where 0=0= no fear and 100=100= maximum fear). The middle part of the form is used for testing the validity of your fearful beliefs and predictions regarding the exposure practice. The first three columns are completed before the practice, and the last column is completed after the practice. 在表格顶部，你应描述你正在练习的具体情境；练习的日期、时间和持续时间；以及练习前后的恐惧程度（使用 0 到 100 分的量表，其中 0=0= 表示无恐惧， 100=100= 表示极度恐惧）。表格中间部分用于检验你对暴露练习中恐惧信念和预测的有效性。前三列在练习前填写，最后一列在练习后填写。
In the first column, record your emotional response to the upcoming practice (responses like fear or nervousness). The second and third columns are used for recording your fearful beliefs and predictions, as well as the evidence regarding the validity of these predictions. (Chapter 6 has many examples of possible fearful beliefs as well as instructions on how to evaluate the evidence concerning these thoughts.) After the practice is completed, record the outcome of the practice (what actually happened), any new evidence generated by the practice, and what you learned about the accuracy of your original anxiety-provoking thoughts and predictions. 在第一栏中，记录你对即将进行的练习的情绪反应（如恐惧或紧张）。第二栏和第三栏用于记录你害怕的信念和预测，以及关于这些预测有效性的证据。（第 6 章有许多可能的害怕信念示例以及如何评估这些想法相关证据的指导。）练习完成后，记录练习的结果（实际发生了什么）、练习产生的任何新证据，以及你对最初引发焦虑的想法和预测准确性的认识。
In the lower part of the form, there is space to record your fear level periodically during the practice, using a scale ranging from 0 (no fear) to 100 (maximum fear). The frequency with which you record your fear ratings will depend on the duration of the practice. For example, ratings might be recorded every minute for a practice lasting ten minutes, or every thirty minutes for a practice lasting all day. There is space to provide up to twenty fear ratings during the practice, though you will probably not need that many. The last step is to plan for your next practice by answering the question, “Based on this experience, what exposure will I do next?” 在表格的下半部分，有空间可以定期记录你在练习过程中的恐惧程度，使用的量表范围是从 0（无恐惧）到 100（极度恐惧）。你记录恐惧评分的频率将取决于练习的持续时间。例如，对于持续十分钟的练习，评分可能每分钟记录一次；对于持续一整天的练习，评分可能每三十分钟记录一次。练习过程中最多可以记录二十次恐惧评分，尽管你可能不需要那么多。最后一步是通过回答“基于这次体验，我下一次将进行什么暴露？”来计划你的下一次练习。
A STEP-BY-STEP GUIDE TO CONDUCTING EXPOSURE TO SOCIAL SITUATIONS 进行社交情境暴露的逐步指南
A comprehensive exposure-based treatment should include the following steps: 一个全面的基于暴露的治疗应包括以下步骤：
Develop a situational exposure hierarchy. Although the hierarchy should be used to guide your exposure practices, you can be flexible. For example, feel free to work on situations that are not on your hierarchy. In addition, you may decide to revise your hierarchy as particular situations become less anxiety-provoking. 制定情境暴露层级。虽然层级应指导你的暴露练习，但你可以灵活处理。例如，可以自由选择不在层级中的情境进行练习。此外，随着某些情境引发的焦虑减轻，你也可以决定修改你的层级。
Plan your exposure practices on a week-by-week basis. At the start of each week, you should have a good idea of the types of practices that you will conduct over the coming week, as well as the dates and times you’ll conduct these practices. 按周计划你的暴露练习。在每周开始时，你应该清楚地知道在接下来的一周内将进行哪些类型的练习，以及进行这些练习的具体日期和时间。
Develop a long-term exposure plan. You should have an idea of the types of situations in which you are likely to conduct exposure practices over the coming months. Of course, this plan probably will change frequently, depending on the results of your practices each week. 制定一个长期的暴露计划。你应该对未来几个月内可能进行暴露练习的情境类型有所了解。当然，这个计划可能会经常变化，具体取决于你每周练习的结果。
Start with exposure to situations that are near the bottom or middle of your hierarchy. If a situation is too difficult, try something easier. If a practice doesn’t create anxiety, try something more difficult. 从层级中靠近底部或中间的情境开始暴露。如果某个情境太难，尝试更简单的。如果某次练习没有引起焦虑，尝试更难的情境。
Gradually increase the difficulty level of practices. As exposures to particular situations become easier, begin practicing exposure in situations that are more anxiety-provoking. 逐步提高练习的难度。当对特定情境的暴露变得更容易时，开始在更能引发焦虑的情境中进行暴露练习。
INTEGRATING SITUATIONAL EXPOSURE STRATEGIES INTO YOUR TREATMENT PLAN 将情境暴露策略整合到您的治疗计划中
Although exposure to feared situations is perhaps the most important technique for overcoming your fear, the exposure methods described in this chapter (and in chapter 7) are often most effective when they are used as part of a comprehensive treatment plan. In addition to situational exposure, your treatment should include the cognitive strategies described in chapter 6, which will help you to reinterpret your experiences during exposure to feared situations. As we reviewed earlier in this book, we recommend that you first practice the cognitive techniques for several weeks before formally beginning exposure practices. 尽管暴露于恐惧情境可能是克服恐惧最重要的技术，但本章（以及第 7 章）中描述的暴露方法通常在作为综合治疗计划的一部分时效果最佳。除了情境暴露之外，您的治疗还应包括第 6 章中描述的认知策略，这些策略将帮助您在暴露于恐惧情境时重新诠释您的体验。正如我们在本书前面所回顾的，我们建议您先练习认知技巧数周，然后再正式开始暴露练习。
Also, your treatment program may include medication (chapter 5), exposure to feared sensations (chapter 9), and social-skills practices (chapter 10), depending on your own personal needs and preferences. As you will see, these strategies are typically used in the context of your own situational exposure practices. Exposure is the foundation around which the other treatment strategies are introduced. 此外，您的治疗方案可能还包括药物治疗（第 5 章）、暴露于恐惧感受（第 9 章）以及社交技能练习（第 10 章），具体取决于您的个人需求和偏好。正如您将看到的，这些策略通常是在您自己的情境暴露练习的背景下使用的。暴露是引入其他治疗策略的基础。
CHAPTER 9 第 9 章
Exposure to Uncomfortable Sensations 暴露于不适感
Symptom exposure (also called interoceptive exposure), involves intentional exposure to internal physical sensations, such as dizziness, racing heart, sweating, shaking, and blushing. This technique was originally developed as a treatment for an anxiety-based condition known as panic disorder. Panic disorder is a problem in which people experience sudden rushes of fear without any obvious trigger or cause. People with panic disorder tend to be very fearful of the physical sensations they experience during their panic attacks, and they often interpret these symptoms as a sign of imminent danger or threat (like an impending heart attack or a complete loss of control). Symptom exposure was developed to teach those with panic disorder to stop fearing the physical feelings associated with physical arousal and anxiety. With repeated exposure to these induced physical symptoms, people learn that these feelings are not dangerous, and they eventually become less frightened of their own internal feelings and sensations. 症状暴露（也称为内感受暴露）涉及有意暴露于内部的身体感觉，如头晕、心跳加速、出汗、颤抖和脸红。这种技术最初是作为治疗一种基于焦虑的疾病——惊恐障碍而开发的。惊恐障碍是一种问题，患者会在没有明显诱因或原因的情况下突然感到恐惧。患有惊恐障碍的人往往非常害怕在惊恐发作期间体验到的身体感觉，他们常常将这些症状解读为即将发生危险或威胁的信号（比如即将心脏病发作或完全失控）。症状暴露的目的是教导惊恐障碍患者停止害怕与身体激活和焦虑相关的身体感觉。通过反复暴露于这些诱发的身体症状，人们会学会这些感觉并不危险，最终他们对自身的内部感觉和感受变得不那么害怕。
Anxiety over experiencing physical arousal symptoms is not unique to panic disorder. A number of studies (Chambless and Gracely 1989; Taylor, Koch, and McNally 1992) have found that people with other anxiety-based problems are also often anxious about experiencing certain physical sensations. This includes people with social anxiety, where the fear may be strongest for sensations that might be visible to others, including blushing, sweating, shaking, and losing one’s train of thought. Just as symptom exposure leads to reduced fear of sensations in people with panic disorder, it makes sense that deliberately exposing oneself to feared symptoms while in social situations might lead to decreased fear of sensations for people with high levels of social anxiety. By combining 对经历身体唤醒症状的焦虑并非惊恐障碍所独有。许多研究（Chambless 和 Gracely 1989；Taylor、Koch 和 McNally 1992）发现，其他基于焦虑的问题患者也常常对某些身体感觉感到焦虑。这包括社交焦虑患者，他们对可能被他人察觉的感觉的恐惧可能最为强烈，比如脸红、出汗、颤抖以及思路中断。正如症状暴露能减少惊恐障碍患者对这些感觉的恐惧一样，有理由相信，在社交场合中有意识地暴露于恐惧的症状，可能会减少高度社交焦虑者对这些感觉的恐惧。通过结合
symptom exposure and situational exposure, you will learn that you can not only tolerate being in feared situations with your usual levels of physical arousal, but that you can tolerate the situation even when your feared physical sensations are particularly intense. By bringing on these sensations in a controlled and predicable way, you will learn to be less anxious about experiencing them in social situations. 症状暴露和情境暴露，你将学会不仅能忍受在恐惧情境中出现的通常身体唤醒水平，还能在恐惧的身体感觉特别强烈时忍受这种情境。通过以可控且可预测的方式引发这些感觉，你将学会在社交场合中对体验这些感觉减少焦虑。
Although there hasn’t been much research on the use of symptom exposure in social anxiety, we have found that this technique is often helpful for those who suffer from excessive social and performance fears (Antony and Swinson 2000; Antony and Rowa 2008). The techniques described in this chapter are not meant to be used instead of the strategies described in earlier chapters. In fact, to overcome your social anxiety, the most important strategies are the cognitive techniques described in chapter 6 and the situational exposure strategies described in chapters 7 and 8. You should not attempt to use symptom exposure until you have practiced the strategies described in chapters 6 through 8 and are thoroughly familiar with them. 尽管关于在社交焦虑中使用症状暴露的研究不多，但我们发现这种技术通常对那些患有过度社交和表现恐惧的人有帮助（Antony 和 Swinson 2000；Antony 和 Rowa 2008）。本章中描述的技术并非用来替代前几章中介绍的策略。事实上，要克服你的社交焦虑，最重要的策略是第 6 章中描述的认知技术以及第 7 章和第 8 章中描述的情境暴露策略。在你练习并熟悉第 6 至第 8 章中描述的策略之前，不应尝试使用症状暴露。
Furthermore, before attempting the symptom exposure techniques, you should be very familiar with the basic rules of exposure. As reviewed in chapter 7, exposure works best if it is practiced frequently, if each practice lasts long enough to show that your feared consequences don’t come true, and if practices are predictable and under your control. In addition, the cognitive strategies described in chapter 6 should be used to combat anxious thinking before, during, and after your exposure practices. Finally, during your exposure practices, you should not use subtle avoidance techniques such as distraction, drug or alcohol use, or other safety behaviors (for example, wearing makeup to hide blushing). 此外，在尝试症状暴露技术之前，你应该非常熟悉暴露的基本规则。如第 7 章所述，暴露效果最佳的条件是频繁练习，每次练习持续足够长的时间以证明你所害怕的后果并未发生，并且练习是可预测且在你控制之下的。此外，第 6 章中描述的认知策略应在暴露练习的前、中、后阶段用来对抗焦虑思维。最后，在暴露练习过程中，你不应使用诸如分散注意力、使用药物或酒精，或其他安全行为（例如，化妆以掩盖脸红）等微妙的回避技巧。
INTRODUCTION TO SYMPTOM EXPOSURE 症状暴露简介
Symptom exposure involves using specific exercises to bring on physical sensations that make you uncomfortable or anxious. Initially, the exercises are practiced in “safe” situations, like your home. After you get used to the exercises, the next step is to try them in anxiety-provoking situations, such as immediately before entering a social or performance situation. Examples of symptom exposure exercises are listed here, along with the sensations they typically trigger (Antony et al. 2006; Antony and Swinson 2000). In addition to this list, there are many other possible exercises that can be used. For example, if you are afraid of a choking or gagging feeling in your throat, wearing a necktie or scarf may be a good way of creating this feeling for the purpose of exposure therapy. It’s best to consider these exercises only as a partial list. At the end of the list, there is space for you to record additional exercises that might be useful for triggering symptoms that you fear. 症状暴露包括使用特定的练习来引发让你感到不适或焦虑的身体感觉。最初，这些练习是在“安全”的环境中进行，比如在家里。等你习惯了这些练习，下一步就是在引发焦虑的情境中尝试它们，比如在进入社交或表演场合之前。这里列出了一些症状暴露练习的例子，以及它们通常引发的感觉（Antony 等，2006；Antony 和 Swinson，2000）。除了这份清单，还有许多其他可能的练习可以使用。例如，如果你害怕喉咙被卡住或作呕的感觉，戴领带或围巾可能是制造这种感觉的好方法，以用于暴露疗法。最好将这些练习仅视为部分清单。在清单末尾，有空间供你记录可能有助于引发你害怕症状的其他练习。
Examples of Symptom Exposure Exercises and Typical Sensations Experienced 症状暴露练习示例及典型体验感觉
Symptom Exposure Exercise 症状暴露练习
Typical Sensations 典型感觉
Shake head from side to side ( 30 sec .) 头部左右摇动（30 秒）
Dizziness, faintness, lightheadedness 头晕，昏厥感，头脑发轻
Spin around in a swivel chair (60 sec.) 在旋转椅上旋转（60 秒）
Dizziness, faintness, lightheadedness 头晕，昏厥感，头脑发轻
Hyperventilate (shallow breathing at a rate of about 100-120 breaths per min.; 60 sec .) 过度换气（浅呼吸，速率约为每分钟 100-120 次；持续 60 秒）
Breathlessness or smothering feelings, dizziness or lightheadedness, racing or pounding heart, feeling unreal, trembling or shaking, numbness or tingling sensations 呼吸急促或窒息感，头晕或头昏，心跳加速或心脏剧烈跳动，感觉不真实，颤抖或发抖，麻木或刺痛感
Breathe through a small, narrow straw (plug your nose if necessary; 2 min .) 通过一根小而窄的吸管呼吸（如有必要捏住鼻子；持续 2 分钟）
Breathlessness or smothering feelings, racing or pounding heart, choking feelings, dizziness or lightheadedness, chest tightness, trembling or shaking 呼吸急促或窒息感，心跳加速或心脏剧烈跳动，窒息感，头晕或头昏，胸部紧绷，颤抖或发抖
Tense all the muscles in the body (60 sec. or as long as possible) 绷紧全身肌肉（60 秒或尽可能长时间）
Trembling or shaking, breathlessness or smothering feelings, racing or pounding heart, dizziness or lightheadedness, blushing 颤抖或抖动，呼吸急促或窒息感，心跳加速或剧烈跳动，头晕或头昏，脸红
Carry heavy weights or bags ( 60 sec . or as long as possible) 提举重物或包（60 秒或尽可能长时间）
Trembling or shaking, breathlessness or smothering feelings, racing or pounding heart, dizziness or lightheadedness, hot flushes 颤抖或抖动，呼吸急促或窒息感，心跳加速或剧烈跳动，头晕或头昏，潮热
Run on the spot or run up and down stairs (60 sec.) 原地跑步或上下楼梯跑（60 秒）
Racing or pounding heart, breathlessness or smothering feelings, chest tightness, sweating, trembling or shaking, blushing 心跳加速或剧烈跳动，呼吸急促或窒息感，胸部紧绷，出汗，颤抖或发抖，脸红
Sit in a hot, stuffy space (for example, a sauna, hot car, or small room with a space heater; 5 to 10 min .) or wear overly warm clothing 坐在闷热的空间里（例如桑拿房、热车内或带有取暖器的小房间；5 到 10 分钟）或穿着过于厚重的衣服
Sweating, breathlessness or smothering feelings, hot flushes, blushing 出汗，呼吸急促或窒息感，潮热，脸红
Have a hot drink or hot soup 喝一杯热饮或热汤
Sweating, blushing, hot flushes 出汗、脸红、潮热
Symptom Exposure Exercise Typical Sensations
Shake head from side to side ( 30 sec .) Dizziness, faintness, lightheadedness
Spin around in a swivel chair (60 sec.) Dizziness, faintness, lightheadedness
Hyperventilate (shallow breathing at a rate of about 100-120 breaths per min.; 60 sec .) Breathlessness or smothering feelings, dizziness or lightheadedness, racing or pounding heart, feeling unreal, trembling or shaking, numbness or tingling sensations
Breathe through a small, narrow straw (plug your nose if necessary; 2 min .) Breathlessness or smothering feelings, racing or pounding heart, choking feelings, dizziness or lightheadedness, chest tightness, trembling or shaking
Tense all the muscles in the body (60 sec. or as long as possible) Trembling or shaking, breathlessness or smothering feelings, racing or pounding heart, dizziness or lightheadedness, blushing
Carry heavy weights or bags ( 60 sec . or as long as possible) Trembling or shaking, breathlessness or smothering feelings, racing or pounding heart, dizziness or lightheadedness, hot flushes
Run on the spot or run up and down stairs (60 sec.) Racing or pounding heart, breathlessness or smothering feelings, chest tightness, sweating, trembling or shaking, blushing
Sit in a hot, stuffy space (for example, a sauna, hot car, or small room with a space heater; 5 to 10 min .) or wear overly warm clothing Sweating, breathlessness or smothering feelings, hot flushes, blushing
Have a hot drink or hot soup Sweating, blushing, hot flushes| Symptom Exposure Exercise | Typical Sensations |
| :--- | :--- |
| Shake head from side to side ( 30 sec .) | Dizziness, faintness, lightheadedness |
| Spin around in a swivel chair (60 sec.) | Dizziness, faintness, lightheadedness |
| Hyperventilate (shallow breathing at a rate of about 100-120 breaths per min.; 60 sec .) | Breathlessness or smothering feelings, dizziness or lightheadedness, racing or pounding heart, feeling unreal, trembling or shaking, numbness or tingling sensations |
| Breathe through a small, narrow straw (plug your nose if necessary; 2 min .) | Breathlessness or smothering feelings, racing or pounding heart, choking feelings, dizziness or lightheadedness, chest tightness, trembling or shaking |
| Tense all the muscles in the body (60 sec. or as long as possible) | Trembling or shaking, breathlessness or smothering feelings, racing or pounding heart, dizziness or lightheadedness, blushing |
| Carry heavy weights or bags ( 60 sec . or as long as possible) | Trembling or shaking, breathlessness or smothering feelings, racing or pounding heart, dizziness or lightheadedness, hot flushes |
| Run on the spot or run up and down stairs (60 sec.) | Racing or pounding heart, breathlessness or smothering feelings, chest tightness, sweating, trembling or shaking, blushing |
| Sit in a hot, stuffy space (for example, a sauna, hot car, or small room with a space heater; 5 to 10 min .) or wear overly warm clothing | Sweating, breathlessness or smothering feelings, hot flushes, blushing |
| Have a hot drink or hot soup | Sweating, blushing, hot flushes |
Other Exercises to Trigger Sensations I Fear 其他引发我害怕感觉的练习
Although symptom exposure is likely to be helpful for many who suffer from social anxiety, it’s usually possible to reduce social anxiety without this particular strategy. In fact, for some people, there may be little reason to use these exercises at all. Symptom exposure is likely to be helpful to you if either of the following statements is true: 虽然症状暴露对许多社交焦虑患者可能有帮助，但通常可以在不使用这种特定策略的情况下减少社交焦虑。事实上，对于某些人来说，可能根本没有必要使用这些练习。如果以下任一陈述适用于你，症状暴露可能对你有帮助：
You are generally afraid of experiencing anxiety symptoms such as a rapidly beating heart, dizziness, shaking, blushing, or sweating. 你通常害怕出现心跳加速、头晕、颤抖、脸红或出汗等焦虑症状。
You are afraid of experiencing anxiety symptoms in front of other people. 你害怕在别人面前出现焦虑症状。
If you’re fearful of experiencing physical arousal feelings in general or when in social or performance situations, we recommend trying the exercises described in this chapter. However, if you are not fearful of the sensations that you experience when anxious, and you are not concerned about others noticing your anxiety symptoms, then there is no need to practice these exercises. In fact, you can skip ahead to chapter 10. 如果你害怕在一般情况下或在社交或表演场合中体验到身体激动的感觉，我们建议尝试本章中描述的练习。然而，如果你不害怕焦虑时体验到的感觉，也不担心别人注意到你的焦虑症状，那么就没有必要练习这些练习。事实上，你可以直接跳到第 10 章。
HOW DOES SYMPTOM EXPOSURE WORK? 症状暴露是如何起作用的？
Like situational exposure, symptom exposure is believed to decrease fear by disproving a person’s fearful beliefs, assumptions, and predictions. By deliberately bringing on uncomfortable feelings in a controlled and predictable way, you will learn that (1) you can control the sensations that normally appear to be uncontrollable and (2) even if you do experience noticeable physical feelings in front of other people, the consequences are likely to be minimal. 像情境暴露一样，症状暴露被认为通过推翻一个人恐惧的信念、假设和预测来减少恐惧。通过以一种可控且可预测的方式故意引发不适感，你将学会（1）你可以控制那些通常看似无法控制的感觉，以及（2）即使你在别人面前确实体验到明显的身体感觉，后果也可能是最小的。
By learning to allow yourself to be anxious in front of other people, and to allow others to observe your anxiety symptoms, eventually you will become less concerned about your anxiety reactions and about what people think when they notice your shaking, sweating, blushing, or other signs of anxiety. By becoming less concerned about experiencing these feelings, you will probably become less anxious when exposed to social and performance situations. 通过学习允许自己在他人面前感到焦虑，并允许他人观察你的焦虑症状，最终你会对自己的焦虑反应以及当别人注意到你的颤抖、出汗、脸红或其他焦虑迹象时他们的看法变得不那么在意。通过减少对这些感受的担忧，当你暴露在社交和表现情境中时，你可能会变得不那么焦虑。
A WARNING ABOUT SYMPTOM EXPOSURE 关于症状暴露的警告
If you are healthy, the exercises described in this chapter are safe. However, if you have certain health problems, some of the exercises could worsen your condition. For example, if you have asthma or a bad cold, you should probably not practice hyperventilation or breathing through a straw. If you experience neck or back pain, we recommend against shaking your head from side to side or engaging in any exercises that could aggravate your condition. To be safe, we recommend checking with your doctor to see if any of these exercises are likely to be dangerous or problematic for you. 如果你身体健康，本章描述的练习是安全的。然而，如果你有某些健康问题，某些练习可能会加重你的病情。例如，如果你患有哮喘或严重感冒，可能不适合练习过度换气或通过吸管呼吸。如果你有颈部或背部疼痛，我们建议不要左右摇头或进行任何可能加重病情的练习。为了安全起见，我们建议你咨询医生，确认这些练习是否对你有潜在危险或问题。
A STEP-BY-STEP GUIDE TO SYMPTOM EXPOSURE 症状暴露的逐步指南
This section describes the four main steps involved in using symptom exposure to overcome the fear of experiencing physical arousal sensations. These include (1) discovering which exercises are most effective for bringing on feared symptoms, (2) developing a symptom exposure hierarchy, (3) practicing the exercises in nonsocial situations, and (4) combining the symptom exposure exercises with exposure practices in social situations. 本节介绍了使用症状暴露法克服对身体激动感受恐惧的四个主要步骤。这些步骤包括：（1）发现哪些练习最有效地引发恐惧症状，（2）制定症状暴露层级，（3）在非社交场合练习这些练习，以及（4）将症状暴露练习与社交场合的暴露练习相结合。
Step 1: Symptom Induction Testing 步骤一：症状诱发测试
Before beginning to practice symptom exposure exercises on a regular basis, you should first determine which exercises are most likely to be effective for you. This can be achieved by attempting each exercise at home and paying attention to the types of symptoms that you experience, the effect of the exercises on your fear level, and how similar the experience is to the fear that you normally experience in social situations. The following Symptom Induction Testing Form can be used to record your responses to each exercise. We have included space for additional exercises that you may have identified earlier in the chapter. 在开始定期练习症状暴露练习之前，您应首先确定哪些练习最可能对您有效。可以通过在家尝试每个练习，注意您体验到的症状类型、练习对您恐惧程度的影响以及体验与您在社交场合通常感受到的恐惧的相似程度来实现。以下的症状诱发测试表可用于记录您对每个练习的反应。我们还为您在本章前面可能已确定的其他练习预留了空间。
Symptom Induction Testing Form 症状诱发测试表
Instructions: After trying each symptom exposure exercise, (1) record the physical sensations that were experienced and (2) rate the intensity of fear experienced using a scale of 0 (no fear) to 100 (maximum fear). 说明：在尝试每个症状暴露练习后，(1) 记录所经历的身体感觉，(2) 使用 0（无恐惧）到 100（极度恐惧）的量表评估所经历的恐惧强度。
Exercise 练习
Sensations Experienced 经历的感觉
Fear (0-100) 恐惧程度（0-100）
Shake head from side to side (30 sec.) 左右摇头（30 秒）
Spin around in a swivel chair (60 sec.) 在旋转椅上旋转（60 秒）
Hyperventilate (shallow breathing at a rate of about 100-120 breaths per min.; 60 sec.) 过度换气（浅呼吸，频率约为每分钟 100-120 次；60 秒）
Breathe through a small, narrow straw (plug your nose if necessary; 2 min.) 通过一个小而窄的吸管呼吸（如有必要，捏住鼻子；2 分钟）
Tense all the muscles in the body (60 sec. or as long as possible) 绷紧全身肌肉（60 秒或尽可能长时间）
Carry heavy weights or bags (60 sec. or as long as possible) 提举重物或提包（60 秒或尽可能长时间）
Run on the spot or run up and down stairs (60 sec.) 原地跑步或上下楼梯跑（60 秒）
Sit in a hot, stuffy space (for example, a sauna, hot car, or small room with a space heater; 5 to 10 min.) or wear overly warm clothing 坐在闷热的空间里（例如桑拿房、热车内或带有取暖器的小房间；5 到 10 分钟）或穿着过于厚重的衣服
Have a hot drink or hot soup 喝一杯热饮或热汤
Other Exercise 其他锻炼
Other Exercise 其他锻炼
Exercise Sensations Experienced Fear (0-100)
Shake head from side to side (30 sec.)
Spin around in a swivel chair (60 sec.)
Hyperventilate (shallow breathing at a rate of about 100-120 breaths per min.; 60 sec.)
Breathe through a small, narrow straw (plug your nose if necessary; 2 min.)
Tense all the muscles in the body (60 sec. or as long as possible)
Carry heavy weights or bags (60 sec. or as long as possible)
Run on the spot or run up and down stairs (60 sec.)
Sit in a hot, stuffy space (for example, a sauna, hot car, or small room with a space heater; 5 to 10 min.) or wear overly warm clothing
Have a hot drink or hot soup
Other Exercise
Other Exercise | Exercise | Sensations Experienced | Fear (0-100) |
| :--- | :--- | :--- |
| Shake head from side to side (30 sec.) | | |
| Spin around in a swivel chair (60 sec.) | | |
| Hyperventilate (shallow breathing at a rate of about 100-120 breaths per min.; 60 sec.) | | |
| Breathe through a small, narrow straw (plug your nose if necessary; 2 min.) | | |
| Tense all the muscles in the body (60 sec. or as long as possible) | | |
| Carry heavy weights or bags (60 sec. or as long as possible) | | |
| Run on the spot or run up and down stairs (60 sec.) | | |
| Sit in a hot, stuffy space (for example, a sauna, hot car, or small room with a space heater; 5 to 10 min.) or wear overly warm clothing | | |
| Have a hot drink or hot soup | | |
| Other Exercise | | |
| Other Exercise | | |
Just as the situational exposure hierarchy described in chapter 8 is used to guide your situational exposure practices, symptom exposure bierarchies are useful for choosing appropriate symptom exposure exercises. In most cases, we recommend that you develop two symptom exposure hierarchies: one for practicing the exercises outside of social situations (see step 3) and a second hierarchy for practicing symptom exposure while in (or immediately before entering) social or performance situations (see step 4). If you are not at all fearful of experiencing anxiety sensations outside of social situations, then developing a hierarchy for practicing symptom exposure in nonsocial situations is less important. Instead, you should focus on exercises to practice while exposed to social and performance situations. 正如第 8 章中描述的情境暴露层级用于指导你的情境暴露练习一样，症状暴露层级对于选择合适的症状暴露练习也非常有用。在大多数情况下，我们建议你制定两个症状暴露层级：一个用于在社交情境之外练习练习（见步骤 3），另一个用于在社交或表演情境中（或即将进入这些情境时）练习症状暴露（见步骤 4）。如果你在社交情境之外完全不害怕体验焦虑感受，那么制定一个用于非社交情境中练习症状暴露的层级就不那么重要了。相反，你应当专注于在社交和表演情境中进行练习的练习。
To develop a hierarchy for symptom exposure, first eliminate any exercises that you know will not make you anxious (based on the results of your symptom induction testing, completed in step 1). For example, if the sensations created by physical exercise (something like jogging) are not frightening to you at all, eliminate this exercise from your list. Next, take the remaining exercises and put them in order of difficulty, with the least anxiety-provoking exercise at the bottom and the most anxiety-provoking item at the top. Record your level of expected fear for each exercise, using a scale ranging from 0 (no fear) to 100 (maximum fear). Examples of symptom exposure hierarchies reflecting practices outside of social situations and practices in social situations follow. We have also included space to record your own hierarchies. 要制定症状暴露的层级，首先排除任何你知道不会让你感到焦虑的练习（基于第一步中完成的症状诱发测试结果）。例如，如果体育锻炼（如慢跑）产生的感觉对你一点也不恐怖，就将这项练习从你的列表中剔除。接下来，将剩余的练习按难度顺序排列，最不引起焦虑的练习放在底部，最引起焦虑的项目放在顶部。使用 0（无恐惧）到 100（极度恐惧）的量表记录你对每项练习预期的恐惧程度。以下是反映非社交情境练习和社交情境练习的症状暴露层级示例。我们还为你提供了记录自己层级的空间。
Sample Symptom Exposure Hierarchy for Practices in Nonsocial Situations 非社交情境练习的症状暴露层级示例
Exercise 练习
Fear Rating (0-100) 恐惧评分（0-100）
1. Hyperventilate at home alone (1 minute). 1. 独自在家过度换气（1 分钟）。
60
2. Breathe through a straw at home alone (2 minutes). 2. 独自在家用吸管呼吸（2 分钟）。
45
3. Spin in a chair at home alone (1 minute). 3. 独自在家坐椅子上旋转（1 分钟）。
35
4. Shake head from side to side at home alone (30 seconds). 4. 独自在家左右摇头（30 秒）。
30
Exercise Fear Rating (0-100)
1. Hyperventilate at home alone (1 minute). 60
2. Breathe through a straw at home alone (2 minutes). 45
3. Spin in a chair at home alone (1 minute). 35
4. Shake head from side to side at home alone (30 seconds). 30| Exercise | Fear Rating (0-100) |
| :--- | :--- |
| 1. Hyperventilate at home alone (1 minute). | 60 |
| 2. Breathe through a straw at home alone (2 minutes). | 45 |
| 3. Spin in a chair at home alone (1 minute). | 35 |
| 4. Shake head from side to side at home alone (30 seconds). | 30 |
My Symptom Exposure Hierarchy for Practices in Nonsocial Situations 我在非社交情境中练习的症状暴露层级
Exercise 练习
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Sample Symptom Exposure Hierarchy for Practices in Social Situations 在社交情境中练习的症状暴露层级示例
Exercise 练习
Fear Rating (0-100) 恐惧评分（0-100）
1. Hold a heavy bag for 60 seconds immediately before holding a filled glass in front of others (to induce shaky hands). 1. 在别人面前拿着装满液体的玻璃杯之前，先拿着一个沉重的包 60 秒（以引起手抖）。
100
2. Breathe through a straw for 2 minutes immediately before entering a cocktail party and making small talk. 2. 在进入鸡尾酒会并进行闲聊之前，先用吸管呼吸 2 分钟。
80
3. Wear a warm sweater while giving a presentation. 3. 在做演讲时穿一件暖和的毛衣。
80
4. Eat hot soup to induce flushing and sweating at a dinner party. 4. 在晚宴上喝热汤以引起脸红和出汗。
60
Exercise Fear Rating (0-100)
1. Hold a heavy bag for 60 seconds immediately before holding a filled glass in front of others (to induce shaky hands). 100
2. Breathe through a straw for 2 minutes immediately before entering a cocktail party and making small talk. 80
3. Wear a warm sweater while giving a presentation. 80
4. Eat hot soup to induce flushing and sweating at a dinner party. 60| Exercise | Fear Rating (0-100) |
| :--- | :--- |
| 1. Hold a heavy bag for 60 seconds immediately before holding a filled glass in front of others (to induce shaky hands). | 100 |
| 2. Breathe through a straw for 2 minutes immediately before entering a cocktail party and making small talk. | 80 |
| 3. Wear a warm sweater while giving a presentation. | 80 |
| 4. Eat hot soup to induce flushing and sweating at a dinner party. | 60 |
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5. Run around the block before entering a party. 40 5. 进入聚会前绕街区跑一圈。40
6. Hyperventilate just before calling someone on the telephone. 35 6. 打电话前先过度换气。35
My Symptom Exposure Hierarchy for Practices in Social Situations 我在社交场合练习的症状暴露层级
Exercise quad\quad 练习 quad\quad
Fear Rating 恐惧评分
(0-100)(0-100)
Fear Rating
(0-100)| Fear Rating |
| :---: |
| $(0-100)$ |
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Step 3: Practicing Symptom Exposure in Nonsocial Situations 步骤 3：在非社交场合练习症状暴露
If you are not fearful of practicing the symptom exposure exercises in nonsocial situations, it is not necessary to spend a lot of time on step 3. However, if there are exercises that you intend to practice in social situations (step 4), we recommend that 如果你在非社交场合练习症状暴露练习时并不感到害怕，那么不必在步骤 3 上花费大量时间。然而，如果你打算在社交场合（步骤 4）练习某些练习，我们建议你
you first try them a few times in nonsocial situations to make sure that you are familiar with the exercise. 先在非社交场合尝试几次，以确保你熟悉该练习。
If there are exercises that are anxiety-provoking for you in nonsocial situations, we recommend that you practice them repeatedly at home or in another comfortable location place before practicing in social situations. Use your symptom exposure hierarchy for nonsocial situations to help you choose which exercises to practice. Begin with exercises that are challenging but unlikely to be so overwhelming that you cannot complete them. After you have chosen an exercise, set aside about fifteen minutes twice a day to practice the exercise repeatedly. After each repetition of the exercise, take a short break (from thirty seconds to a few minutes) until the symptoms decrease. Continue to practice the exercise another five or six times or until your fear has decreased. Later in this chapter, you will find a diary you can use to record the results of each practice and to challenge any anxiety-provoking thoughts that arise during the practice. 如果在非社交情境中有让你感到焦虑的练习，我们建议你先在家中或其他舒适的地方反复练习，然后再在社交情境中练习。使用你为非社交情境制定的症状暴露层级，帮助你选择要练习的项目。先从那些具有挑战性但不至于让你无法完成的练习开始。选定练习后，每天安排大约十五分钟，分两次反复练习。每次练习后，休息一小会儿（从三十秒到几分钟不等），直到症状减轻。继续练习该项目五到六次，或者直到你的恐惧感减弱。本章后面你会找到一个日记表，可以用来记录每次练习的结果，并挑战练习过程中出现的任何引发焦虑的想法。
Each time you complete an exercise, you will experience the physical symptoms associated with it. However, your fear of the symptoms should decrease across individual practices and across days. For example, if you are practicing hyperventilation, you will likely continue to become hot and lightheaded each time you do the exercise. However, over time, these feelings should become less frightening. 每次完成一个练习时，你都会体验到与之相关的身体症状。然而，你对这些症状的恐惧应该会随着每次练习和每天的进行而减少。例如，如果你正在练习过度换气，每次做这个练习时你可能仍会感到发热和头晕。但随着时间的推移，这些感觉应该会变得不那么可怕。
Step 4: Practicing Symptom Exposure in Social Situations 步骤 4：在社交场合中练习症状暴露
After you have practiced situational exposure (chapter 8) and symptom exposure in nonsocial situations, the next step is to combine these two approaches. Combining symptom and situational exposure is one of the most challenging types of exposure that you can practice. However, this type of exposure can also provide you with the strongest possible evidence that your anxious predictions are exaggerated or untrue. By entering the social and performance situations that you fear and purposefully inducing arousal sensations to enhance your fear, you will learn that these situations are manageable even when you feel extremely uncomfortable. To select possible exercises for combining symptom and situational exposure, refer back to your symptom exposure hierarchy for practices in social situations (step 2). 在你练习了情境暴露（第 8 章）和非社交情境下的症状暴露之后，下一步是将这两种方法结合起来。结合症状暴露和情境暴露是你可以练习的最具挑战性的暴露类型之一。然而，这种暴露也能为你提供最有力的证据，证明你的焦虑预测是夸大或不真实的。通过进入你害怕的社交和表现情境，并有意识地引发激动感以增强你的恐惧，你将学会即使感到极度不适，这些情境也是可以应对的。要选择结合症状和情境暴露的可能练习，请回顾你在社交情境中症状暴露的层级表（步骤 2）。
INTEGRATING SYMPTOM EXPOSURE INTO YOUR TREATMENT PLAN 将症状暴露整合到你的治疗计划中
As discussed earlier, we recommend that your psychological treatment program (cognitive behavioral therapy) begin with the cognitive strategies discussed in chapter 6. After practicing the cognitive techniques for several weeks, you should practice situational exposure for several more weeks or months until you feel more comfortable in social situations (chapters 7 and 8). Only then should you consider adding symptom exposure 如前所述，我们建议您的心理治疗方案（认知行为疗法）从第 6 章讨论的认知策略开始。在练习认知技巧数周后，您应继续练习情境暴露数周或数月，直到您在社交场合中感到更加舒适（第 7 章和第 8 章）。只有在此之后，您才应考虑加入症状暴露。
if you are still fearful of experiencing anxiety symptoms in front of others. As your fear continues to decrease through exposure and cognitive therapy, you may also consider working on your social and communication skills (chapter 10). 如果您仍然害怕在他人面前出现焦虑症状。当通过暴露疗法和认知疗法您的恐惧持续减轻时，您也可以考虑提升您的社交和沟通技巧（第 10 章）。
USING SYMPTOM EXPOSURE RECORDS AND DIARIES 使用症状暴露记录和日记
Keeping good records during symptom exposure practices will help you to monitor your progress over time. The Symptom Exposure Diary at the end of this chapter will help you to measure changes in your fear across symptom exposure practices. Furthermore, this diary is designed to help you challenge your anxious thoughts during exposure practices. The first column indicates the trial number ( 1,2,31,2,3, and so on). In the second column, you should record the specific sensations that you experience. In the third column, record your fear level during each exercise trial. Finally, the fourth and fifth columns are for recording your anxious thoughts during the exercise and for countering your thoughts with more realistic beliefs. 在症状暴露练习过程中保持良好的记录将帮助你随着时间监测自己的进展。本章末尾的症状暴露日记将帮助你衡量在症状暴露练习中恐惧感的变化。此外，这本日记旨在帮助你在暴露练习中挑战你的焦虑想法。第一栏表示试验次数（ 1,2,31,2,3 ，依此类推）。第二栏应记录你所体验的具体感觉。第三栏记录每次练习试验中的恐惧程度。最后，第四和第五栏用于记录练习中的焦虑想法以及用更现实的信念来反驳这些想法。
TROUBLESHOOTING 故障排除
Problem: The symptom exposure exercises don’t frighten me. 问题：症状暴露练习并没有让我感到害怕。
Solution: If the exercises don’t cause anxiety when you practice them in nonsocial situations, try practicing them immediately before entering social situations. If they still don’t increase your fear, then discontinue the symptom exposure exercises. However, you should continue to use the cognitive strategies (chapter 6) and the situational exposure exercises (chapters 7 and 8). 解决方案：如果你在非社交场合练习时这些练习没有引起焦虑，试着在进入社交场合前立即练习它们。如果它们仍然没有增加你的恐惧感，那么可以停止症状暴露练习。然而，你应继续使用认知策略（第 6 章）和情境暴露练习（第 7 章和第 8 章）。
Problem: The symptom exposure exercises are too overwhelming for me to complete. 问题：症状暴露练习对我来说过于压倒性，无法完成。
Solution: If a symptom exposure exercise is too overwhelming, even when conducted in a nonsocial situation, try an easier exercise from your hierarchy and don’t move on to the more difficult exercises until the easier ones become manageable. If you find that a symptom exposure exercise is overwhelming only when practiced in the context of a social or performance situation, you can practice an easier exercise from your symptom exposure hierarchy and work your way up to the more difficult exercises. Or, you can continue to practice situational exposure without the symptom exposure exercises. Hold off on introducing symptom exposure practices in social situations until you are able to manage the situation on its own (without symptom exposure). 解决方案：如果症状暴露练习即使在非社交情境下进行也过于压倒性，可以尝试从你的层级中选择一个较简单的练习，直到较简单的练习变得可控后再进行更难的练习。如果你发现症状暴露练习仅在社交或表演情境中进行时感到压倒性，可以先练习症状暴露层级中较简单的练习，逐步过渡到更难的练习。或者，你也可以继续进行情境暴露练习，而不进行症状暴露练习。在你能够单独应对社交情境（不进行症状暴露）的情况下，再考虑引入社交情境中的症状暴露练习。
Symptom Exposure Diary 症状暴露日记
Instructions: This form should be completed each time you practice symptom exposure. For each symptom exposure trial: (1) list the physical symptoms that you experienced; (2) rate the intensity of your fear using a scale of 0 (no fear) to 100 (maximum fear); (3) list your specific anxious predictions regarding the exercise (What might happen during the exercise?); and (4) list alternative nonanxious predictions and evidence supporting these nonanxious predictions (countering). 说明：每次进行症状暴露练习时都应填写此表格。对于每次症状暴露试验：（1）列出你所经历的身体症状；（2）使用 0（无恐惧）到 100（极度恐惧）的量表评估你的恐惧强度；（3）列出你对该练习的具体焦虑预测（练习过程中可能发生什么？）；（4）列出替代的非焦虑预测及支持这些非焦虑预测的证据（反驳）。
Exposure Exercise 暴露练习
Date and Time 日期和时间
Adapted from Antony, M.M., and R. P. Swinson. 2000. Phobic Disorders and Panic in Adults: A Guide to Assessment and Treatment. Washington, DC: American Psychological Association. Used with permission. 改编自 Antony, M.M.和 R. P. Swinson. 2000.《成人恐惧症和惊恐障碍：评估与治疗指南》。华盛顿特区：美国心理学会。经许可使用。 qquad\qquad qquad\qquad
Trial # 试验编号
Sensations Experienced 体验到的感觉
Fear 恐惧
Anxiety-Provoking Thoughts and Predictions 引发焦虑的想法和预测
Are there times when your behavior communicates to others a message that’s different from what you are trying to communicate? Do you freeze up in interviews? Do you tend to avoid eye contact when talking to other people? Does your body language tell others to stay away? Do you read your presentations verbatim so you don’t make any mistakes? Do others often feel as though you aren’t listening to them? Do people misinterpret your shyness as a sign of aloofness or a snobby attitude? This chapter is all about how to communicate effectively and to get your message across in the way you intend. 有没有时候你的行为向别人传达的信息与你想表达的不同？你在面试时会僵住吗？你和别人说话时是否倾向于避免眼神交流？你的肢体语言是否在告诉别人远离？你是否逐字逐句地朗读演讲稿以避免出错？别人是否常觉得你没有在听他们说话？人们是否误将你的害羞解读为冷漠或傲慢？本章将讲述如何有效沟通，并以你期望的方式传达你的信息。
GETTING YOUR MESSAGE ACROSS 传达你的信息
For some people, a consequence of avoiding social situations is never having the opportunity to master the communication skills that would help them deal effectively with others. For example, if your fear has stopped you from applying for jobs or asking people out on dates, you may not always know how to best deal with these situations (what to say, what to wear, how to behave, and so on). The ability to interact effectively with other people must be learned and it takes practice, just like learning to play the piano or training to run a marathon. As you get more experience being in the situations you avoid, and learning what works and what doesn’t, your performance is likely to improve. This chapter provides ideas for enhancing the quality of your interactions with other people. Most of these strategies can be used during the course of your situational exposure practices (chapters 7 and 8). 对于一些人来说，避免社交场合的一个后果是永远没有机会掌握那些能够帮助他们有效与他人交往的沟通技巧。例如，如果你的恐惧阻止了你申请工作或约人出去约会，你可能并不总是知道如何最好地处理这些情况（说什么、穿什么、如何表现等等）。与他人有效互动的能力必须通过学习获得，并且需要练习，就像学习弹钢琴或训练跑马拉松一样。随着你在那些你曾避免的情境中积累更多经验，了解什么有效、什么无效，你的表现很可能会有所提升。本章提供了提升你与他人互动质量的思路。这些策略中的大多数可以在你进行情境暴露练习（第 7 章和第 8 章）时使用。
As you read this chapter, there are a few important points to keep in mind. First, our purpose in writing this chapter is not to suggest that you lack social skills. In fact, most people we have worked with who have problems with social anxiety have fine social skills overall. If anything, your social and communication skills are probably already much better than you think they are. Rather, our aim is to help you increase your awareness of the different ways in which your behavior may impact others and to change specific behaviors where appropriate. 在阅读本章时，有几点重要事项需要牢记。首先，我们写这章的目的并不是暗示你缺乏社交技巧。事实上，我们接触过的大多数有社交焦虑问题的人整体上社交技巧都很好。实际上，你的社交和沟通能力很可能比你自己想象的要好得多。我们的目标是帮助你提高对自己行为如何影响他人的不同方式的认识，并在适当的情况下改变特定的行为。
You should also bear in mind that there is no such thing as perfect social skills. What works best in one situation or with one group of people may not work well in another situation or with another group. For example, the best way to ask one person out on a date may cause a rejection from someone else. Although a particular style may help you get one job, it may work against you for another job or with another interviewer. In other words, no matter how well-developed your social skills are, they can never be perfect. Like everyone, you will continue to stumble from time to time and occasionally you will make a bad impression on other people. 你还应记住，完美的社交技巧是不存在的。在一种情境或一群人中最有效的方法，可能在另一种情境或另一群人中并不奏效。例如，向某人约会的最佳方式，可能会被另一个人拒绝。虽然某种风格可能帮助你获得一份工作，但在另一份工作或面对另一位面试官时，可能会对你不利。换句话说，无论你的社交技巧多么娴熟，都不可能完美。像所有人一样，你仍会时不时地犯错，偶尔也会给别人留下不好的印象。
Finally, the strategies described in this chapter should not be thought of as rules to be followed by everyone. Rather, they are suggestions and guidelines that you may find helpful in some situations. For example, we suggest that certain types of body language (for example, standing too far away from another person during a conversation) may be interpreted as a sign of aloofness or that you are uninterested in talking. However, standing too close also may cause other people to feel uncomfortable. Unfortunately, it’s very difficult to determine the ideal amount of “personal space.” What works well with one person may not work as well with another. Personal space preferences also vary across ethnic groups and subcultures. That is, among some groups, standing quite close to the person with whom you’re speaking is the norm. But in another group that norm might cause great discomfort. Given that it is often difficult to know how to behave in a particular situation, it’s best not to get too caught up in whether you are using these strategies perfectly or whether you’re making a perfect impression on others. 最后，本章中描述的策略不应被视为每个人都必须遵循的规则。相反，它们是一些建议和指导，您可能会在某些情况下觉得有帮助。例如，我们建议某些类型的肢体语言（例如，在交谈时站得离对方太远）可能被解读为冷漠或对交谈不感兴趣的信号。然而，站得太近也可能让别人感到不舒服。不幸的是，很难确定理想的“个人空间”距离。对一个人有效的方法，可能对另一个人效果不佳。个人空间的偏好也因族群和亚文化而异。也就是说，在某些群体中，站得离交谈对象很近是常态，但在另一些群体中，这种距离可能会引起极大的不适。鉴于在特定情境下如何表现往往难以把握，最好不要过于纠结于自己是否完美地运用了这些策略，或是否给他人留下了完美的印象。
Examples of communication skills discussed in this chapter are provided here. As you read through the list, pay attention to the specific skills you are interested in improving. 本章讨论的沟通技巧示例如下。在阅读列表时，请注意您感兴趣并希望改进的具体技能。
Skill 技能
Examples 示例
Listening skills 倾听技巧
- Listening carefully to others when they are speaking, instead of comparing yourself to the other person, ruminating about what you will say next, and so on - 当别人说话时，认真倾听，而不是与对方比较，反复思考接下来要说什么，等等
- Making appropriate eye contact when talking to other people
- Attending to body language
- Standing at an appropriately close distance to other people during conversations
- Smiling appropriately
- Speaking with a confident tone and a volume level that others can hear
- Making appropriate eye contact when talking to other people
- Attending to body language
- Standing at an appropriately close distance to other people during conversations
- Smiling appropriately
- Speaking with a confident tone and a volume level that others can hear| - Making appropriate eye contact when talking to other people |
| :--- |
| - Attending to body language |
| - Standing at an appropriately close distance to other people during conversations |
| - Smiling appropriately |
| - Speaking with a confident tone and a volume level that others can hear |
- Disclosing information about yourself when appropriate
- Starting and stopping conversations
- Keeping conversations flowing
- Not putting yourself down in front of others
- Not apologizing unnecessarily
- Disclosing information about yourself when appropriate| - Starting and stopping conversations |
| :--- |
| - Keeping conversations flowing |
| - Not putting yourself down in front of others |
| - Not apologizing unnecessarily |
| - Disclosing information about yourself when appropriate |
Interview skills 面试技巧
- 准备面试
- 决定穿什么
- 预判面试官的问题
- 准备要问的问题
- 面试结束后该做什么
- Preparing for interviews
- Deciding what to wear
- Anticipating the interviewer's questions
- Preparing questions to ask
- What to do after the interview is over
- Preparing for interviews
- Deciding what to wear
- Anticipating the interviewer's questions
- Preparing questions to ask
- What to do after the interview is over| - Preparing for interviews |
| :--- |
| - Deciding what to wear |
| - Anticipating the interviewer's questions |
| - Preparing questions to ask |
| - What to do after the interview is over |
- Communicating assertively rather than in a way that is either too passive or too aggressive; asking for what you want
- Dealing with conflict, particularly with people with whom you disagree or who might be angry or hostile toward you
- Learning the difference between imposing on others' time and privacy vs. making a reasonable request for help or social contact
- Communicating assertively rather than in a way that is either too passive or too aggressive; asking for what you want
- Dealing with conflict, particularly with people with whom you disagree or who might be angry or hostile toward you
- Learning the difference between imposing on others' time and privacy vs. making a reasonable request for help or social contact| - Communicating assertively rather than in a way that is either too passive or too aggressive; asking for what you want |
| :--- |
| - Dealing with conflict, particularly with people with whom you disagree or who might be angry or hostile toward you |
| - Learning the difference between imposing on others' time and privacy vs. making a reasonable request for help or social contact |
Skills for meeting new people and dating 结识新朋友和约会的技巧
- Basic manners
- Finding people to date
- Asking someone to lunch or dinner
- Generating conversation topics
- Ending a date gracefully
- Dealing with rejection| - Basic manners |
| :--- |
| - Finding people to date |
| - Asking someone to lunch or dinner |
| - Generating conversation topics |
| - Ending a date gracefully |
| - Dealing with rejection |
Public speaking and presentation skills 公众演讲和演示技巧
- 吸引观众 - 设计幻灯片及其他视听辅助工具 - 组织你的演讲 - 处理观众提问
- Engaging the audience
- Designing slides and other audiovisual aids
- Organizing your talk
- Handling questions from the audience
- Engaging the audience
- Designing slides and other audiovisual aids
- Organizing your talk
- Handling questions from the audience| - Engaging the audience |
| :--- |
| - Designing slides and other audiovisual aids |
| - Organizing your talk |
| - Handling questions from the audience |
Skill Examples
Listening skills - Listening carefully to others when they are speaking, instead of comparing yourself to the other person, ruminating about what you will say next, and so on
Nonverbal communication skills "- Making appropriate eye contact when talking to other people
- Attending to body language
- Standing at an appropriately close distance to other people during conversations
- Smiling appropriately
- Speaking with a confident tone and a volume level that others can hear"
Conversation skills "- Starting and stopping conversations
- Keeping conversations flowing
- Not putting yourself down in front of others
- Not apologizing unnecessarily
- Disclosing information about yourself when appropriate"
Interview skills "- Preparing for interviews
- Deciding what to wear
- Anticipating the interviewer's questions
- Preparing questions to ask
- What to do after the interview is over"
Assertiveness skills "- Communicating assertively rather than in a way that is either too passive or too aggressive; asking for what you want
- Dealing with conflict, particularly with people with whom you disagree or who might be angry or hostile toward you
- Learning the difference between imposing on others' time and privacy vs. making a reasonable request for help or social contact"
Skills for meeting new people and dating "- Basic manners
- Finding people to date
- Asking someone to lunch or dinner
- Generating conversation topics
- Ending a date gracefully
- Dealing with rejection"
Public speaking and presentation skills "- Engaging the audience
- Designing slides and other audiovisual aids
- Organizing your talk
- Handling questions from the audience"| Skill | Examples |
| :--- | :--- |
| Listening skills | - Listening carefully to others when they are speaking, instead of comparing yourself to the other person, ruminating about what you will say next, and so on |
| Nonverbal communication skills | - Making appropriate eye contact when talking to other people <br> - Attending to body language <br> - Standing at an appropriately close distance to other people during conversations <br> - Smiling appropriately <br> - Speaking with a confident tone and a volume level that others can hear |
| Conversation skills | - Starting and stopping conversations <br> - Keeping conversations flowing <br> - Not putting yourself down in front of others <br> - Not apologizing unnecessarily <br> - Disclosing information about yourself when appropriate |
| Interview skills | - Preparing for interviews <br> - Deciding what to wear <br> - Anticipating the interviewer's questions <br> - Preparing questions to ask <br> - What to do after the interview is over |
| Assertiveness skills | - Communicating assertively rather than in a way that is either too passive or too aggressive; asking for what you want <br> - Dealing with conflict, particularly with people with whom you disagree or who might be angry or hostile toward you <br> - Learning the difference between imposing on others' time and privacy vs. making a reasonable request for help or social contact |
| Skills for meeting new people and dating | - Basic manners <br> - Finding people to date <br> - Asking someone to lunch or dinner <br> - Generating conversation topics <br> - Ending a date gracefully <br> - Dealing with rejection |
| Public speaking and presentation skills | - Engaging the audience <br> - Designing slides and other audiovisual aids <br> - Organizing your talk <br> - Handling questions from the audience |
Of course, it is impossible to thoroughly cover all of these topics in a single chapter. Indeed, numerous books have been written on each of these particular domains (presentations, interviews, dating, assertiveness, listening, and so on). For more detailed suggestions, consult some of the recommended readings cited throughout this chapter and in the list of additional recommended readings at the back of the book. In addition, there are a number of good books that cover a wide range of topics related to social and communication skills. Some examples include Messages: The Communication Skills Book (McKay, Davis, and Fanning 1995), The Messages Workbook: Powerful Strategies for Effective Communication at Work & Home (Davis, Paleg, and Fanning 2004), and Robert Bolton’s classic book, People Skills (1979). 当然，不可能在一章中详尽涵盖所有这些主题。实际上，关于每个具体领域（演讲、面试、约会、自信、倾听等）都有大量专著。欲获取更详细的建议，请参考本章中引用的推荐读物以及书后附录中的额外推荐读物列表。此外，还有许多优秀的书籍涵盖了与社交和沟通技巧相关的广泛主题。例如，《Messages: The Communication Skills Book》（McKay, Davis, 和 Fanning 1995）、《The Messages Workbook: Powerful Strategies for Effective Communication at Work & Home》（Davis, Paleg, 和 Fanning 2004）以及 Robert Bolton 的经典著作《People Skills》（1979）。
Finally, you may want to check out a website that uses video to demonstrate how to do a wide range of things—everything from sewing to cooking to magic tricks. The site is www.videojug.com. In addition to being a great place to learn all sorts of interesting skills, the site includes video demonstrations of various social behaviors, including making a good first impression, dating, hugging, kissing, complaining appropriately, looking approachable, and even how to give a great handshake! Just search for the behavior you want to see. 最后，你可能想看看一个使用视频来演示如何做各种事情的网站——从缝纫到烹饪再到魔术技巧应有尽有。该网站是 www.videojug.com。除了是学习各种有趣技能的好地方外，网站还包括各种社交行为的视频演示，包括如何给人留下良好的第一印象、约会、拥抱、亲吻、适当抱怨、看起来平易近人，甚至如何握手握得很棒！只需搜索你想看的行为即可。
LEARNING TO LISTEN 学习倾听
Communication is a two-way street. Listening effectively when you are in a conversation, being interviewed, or participating in a meeting is as important as what you say. When you feel anxious, your attention tends to shift from the situation itself to your own experiences in the situation. In other words, you become aware of how you’re feeling, and you begin to wonder whether your anxiety symptoms are noticeable to the other people in the room and whether those people are judging you negatively. At the same time, you become less aware of other aspects of the situation, including what other people are saying. This lack of concentration on what others are saying may reinforce your uncertainty about whether your responses are appropriate. Often, even when you think you are listening, you may be only partially aware of what is being said. 交流是双向的。在对话中、接受采访时或参加会议时，有效倾听和你所说的话同样重要。当你感到焦虑时，你的注意力往往会从情境本身转移到你在情境中的自身体验。换句话说，你会意识到自己的感受，并开始担心你的焦虑症状是否被在场的其他人察觉，以及这些人是否在对你做出负面评价。与此同时，你对情境的其他方面，包括别人说的话，变得不那么关注。这种对他人言语缺乏专注，可能会加剧你对自己反应是否恰当的不确定感。通常，即使你认为自己在倾听，也可能只是部分意识到所说内容。
There are several costs to not listening. First, you may miss important information that the other person is trying to communicate. You may hear only the parts of the message that are consistent with your anxious beliefs, thereby increasing your anxiety. For example, if you hear only your boss’ negative comments and miss his or her praise during a performance evaluation, you will undoubtedly feel worse than if you had heard the entire evaluation. Not hearing the entire message also may lead you to respond inappropriately, sometimes to something completely different than what was actually said. Furthermore, the other person may sense that you are not listening to what is being said. As a result, you may be perceived by that person as aloof, distracted, or bored by the conversation. 不倾听有几个代价。首先，你可能会错过对方试图传达的重要信息。你可能只听到与自己焦虑信念一致的部分信息，从而加剧你的焦虑。例如，如果你只听到老板在绩效评估中的负面评论，而忽略了他的表扬，你无疑会比听到整个评估时感觉更糟。没有听完整个信息也可能导致你做出不恰当的回应，有时甚至回应的内容与实际说的完全不同。此外，对方可能会察觉到你没有在认真听他说的话。因此，你可能会被对方认为是冷漠、心不在焉或对谈话感到无聊。
Blocks to Effective Listening 有效倾听的障碍
In Messages: The Communication Skills Book, authors McKay, Davis, and Fanning list a number of different factors that frequently interfere with our ability to listen to others during conversations, meetings, arguments, and other types of social interactions. Of these, five are especially common when people feel anxious in a social situation. These listening blocks include the following: 在《Messages: The Communication Skills Book》一书中，作者 McKay、Davis 和 Fanning 列举了许多常见因素，这些因素经常干扰我们在对话、会议、争论及其他社交互动中倾听他人的能力。其中，有五种在人们在社交场合感到焦虑时尤为常见。这些倾听障碍包括以下内容：
Comparing yourself to the other person. We all compare ourselves to others as a way to evaluate our own behavior and accomplishments. However, excessive social anxiety may be associated with the tendency to do this more often, to make unfavorable comparisons (for instance, comparisons with those who are more successful on a particular dimension), and to feel bad after making such comparisons. This tendency to make negative comparisons while conversing (for example, criticizing yourself with unspoken comments such as, “I’m not as smart as he is” or “She is more attractive than I am”) interferes with your ability to listen to and hear what is being said. 将自己与对方进行比较。我们都会通过与他人比较来评估自己的行为和成就。然而，过度的社交焦虑可能会导致这种比较行为更频繁，且倾向于做出不利的比较（例如，与在某一方面更成功的人比较），并在比较后感到沮丧。这种在交谈中做出负面比较的倾向（例如，用无声的评论批评自己，如“我没有他聪明”或“她比我更有吸引力”）会干扰你倾听和理解对方所说内容的能力。
Filtering what the other person says. Filtering involves listening only to certain parts of what the other person is saying. In social anxiety, this can involve paying attention only to those parts of the conversation that seem to indicate that the other person is being critical or judgmental. 过滤对方所说的话。过滤指的是只听对方所说内容的某些部分。在社交焦虑中，这可能表现为只关注那些似乎表明对方在批评或评判自己的对话内容。
Rehearsing what to say next. When people are overly concerned about saying the right thing during conversations or meetings, they often rehearse mentally how they will respond to other people’s comments rather than truly listening to what is being said. Although you may engage in rehearsal to make sure you say the right thing, this practice, if used too often, may have the opposite effect. 排练接下来要说的话。当人们过于担心在对话或会议中说出正确的话时，他们常常在心里排练如何回应他人的评论，而不是认真听对方说了什么。虽然你可能通过排练来确保说出合适的话，但如果过于频繁地使用这种方法，反而可能产生相反的效果。
Derailing the conversation. Derailing involves switching the topic of conversation when it becomes either boring or uncomfortable. In social anxiety, derailing may take place when the conversation moves into anxiety-provoking areas. For example, if a coworker asks you about your weekend and you are embarrassed to admit that you stayed home alone all weekend, you might shift the conversation back to a work-related topic, rather than disclose what you perceive to be overly personal information. Derailing can make the other person feel as though you are not listening or are not interested in the conversation. 打断谈话。打断谈话指的是当话题变得无聊或令人不适时，转换谈话主题。在社交焦虑中，当谈话进入引发焦虑的领域时，可能会发生打断。例如，如果同事问你周末过得怎么样，而你因为尴尬而不愿承认整个周末都独自待在家里，你可能会将话题转回与工作相关的内容，而不是透露你认为过于私人的信息。打断谈话可能会让对方觉得你没有在听或者对谈话不感兴趣。
Placating the other person. Placating involves agreeing with the other person regardless of what he or she says in an effort to avoid potential conflict. Because social anxiety is associated with a fear of being disliked or negatively judged, people who are socially anxious often go out of their way to agree with others. However, most people don’t expect to have others agree 安抚对方。安抚指的是无论对方说什么，都表示同意，以避免潜在的冲突。由于社交焦虑与害怕被讨厌或负面评价有关，社交焦虑者常常不遗余力地同意他人。然而，大多数人并不期望别人总是同意
with them all the time. If you always agree with whatever is said, it may raise the other person’s suspicions about whether you’re really listening. 他们的观点。如果你总是同意对方说的任何话，可能会引起对方怀疑你是否真的在听。
Improving Your Listening Skills 提升你的倾听技巧
The authors of Messages provide a number of suggestions for improving listening skills. First, they suggest that effective listening should involve active participation rather than just sitting quietly and absorbing the information. Active listening involves maintaining appropriate eye contact, paraphrasing what the person has said (“So, in other words, what you are saying is . . .”), asking for clarification (asking questions to help you understand what was said), and providing the other person with feedback (or your reactions to what he or she said). Whenever possible, feedback should be immediate (as soon as you understand the communication), honest (reflecting your true feelings), and supportive (in other words, gentle and unlikely to be hurtful to the other person). 《Messages》的作者提供了许多提高听力技巧的建议。首先，他们建议有效的倾听应当是积极参与的，而不仅仅是安静地坐着吸收信息。积极倾听包括保持适当的眼神交流，复述对方所说的话（“换句话说，你的意思是……”），请求澄清（通过提问帮助你理解所说内容），并向对方提供反馈（或你对他说的话的反应）。只要可能，反馈应当是即时的（在你理解交流内容后立即给予）、诚实的（反映你的真实感受）以及支持性的（换句话说，温和且不易伤害对方）。
In addition, it’s important to listen with empathy. Being empathic means conveying the idea that you genuinely understand the other person’s message as well as the feelings he or she is experiencing. As discussed in chapter 6, there are many different ways of interpreting a given situation. By trying to understand another person’s perspective, you will be better able to listen and to communicate that fact. Note that it is not necessary for you to agree with the other person’s perspective-just to understand it. However, even when someone says something that you believe to be completely incorrect, you probably can identify at least a small part of the message that is true. Letting the person know that you understand his or her perspective conveys empathy, even if you don’t agree with the overall content of what was said. 此外，倾听时带有同理心也很重要。同理心意味着传达出你真正理解对方所传达的信息以及他或她所经历的感受。正如第 6 章所讨论的，对于同一情境有许多不同的解读方式。通过尝试理解他人的视角，你将更好地倾听并传达这一事实。请注意，你不必认同对方的观点——只需理解即可。然而，即使有人说了你认为完全错误的话，你也可能能识别出信息中至少一小部分是真实的。让对方知道你理解他或她的观点，即使你不同意所说内容的整体，也能传达出同理心。
Finally, effective listening requires listening with openness and awareness. Openness involves listening without trying to find fault. Awareness involves (1) being aware of how a communication fits in with your own knowledge and experiences, and (2) being aware of any inconsistencies in the verbal message itself and the nonverbal aspects of the communication, such as tone, posture, and facial expressions. 最后，有效的倾听需要以开放和觉察的态度去倾听。开放意味着倾听时不试图挑毛病。觉察包括（1）意识到一段交流如何与你自身的知识和经验相契合，以及（2）注意言语信息本身与交流中的非语言方面（如语调、姿势和面部表情）之间的任何不一致之处。
Exercise: Effective Listening 练习：有效倾听
The next time you’re in a conversation, try some of the effective listening skills described above: 下次你参与对话时，尝试运用上述一些有效倾听技巧：
Make eye contact during the conversation. 在对话过程中保持眼神交流。
Paraphrase what the other person says, and ask for clarification if you’re unsure about any aspect of the communication. 复述对方所说的话，如果对交流的任何方面不确定，请寻求澄清。
Give feedback when appropriate, making sure that your feedback is immediate, honest, and supportive. 在适当的时候给予反馈，确保你的反馈是及时、诚实且支持性的。
Finally, make sure that you are listening with empathy, openness, and awareness. 最后，确保你以同理心、开放和觉察的态度倾听。
After trying this exercise in a real-life situation, come back to this chapter and list on the lines below any ways in which the experience was different from your usual conversations. Did the conversation last longer? Was it more gratifying? Did the other person respond differently to you? Did you experience less anxiety than usual? 在现实生活中尝试这个练习后，回到本章，在下面的空白处列出这次经历与平常对话有何不同。对话持续时间更长了吗？是否更令人满意？对方对你的反应有变化吗？你是否比平时感到更少的焦虑？
NONVERBAL COMMUNICATION 非语言交流
When you feel anxious in a social situation, you probably engage in behaviors designed to subtly avoid communicating with others. These may include avoiding eye contact, speaking very quietly, or even avoiding the situation completely. Despite your efforts to avoid communication, however, it’s virtually impossible not to communicate. In fact, what you actually say in words during a conversation makes up a very small component of the messages you communicate to others. Nonverbal aspects of communication, including your physical distance from others, eye contact, posture, tone of voice, and vocal volume communicate at least as much information as your verbal messages. In fact, even when you completely stay away from a feared social situation, you communicate a message to others. For example, if you repeatedly avoid meetings at work, others may assume that you are shy, uninterested, or even unfriendly. 当你在社交场合感到焦虑时，你可能会采取一些行为，试图巧妙地避免与他人交流。这些行为可能包括避免眼神接触、说话声音很小，甚至完全回避该场合。然而，尽管你努力避免交流，但实际上几乎不可能不进行交流。事实上，在对话中你用言语表达的内容只占你传达给他人的信息的一小部分。非语言交流的方面，包括你与他人的身体距离、眼神接触、姿势、语调和声音音量，传递的信息至少和你的言语信息一样多。实际上，即使你完全避开一个令你害怕的社交场合，你也在向他人传递信息。例如，如果你反复避免参加工作会议，别人可能会认为你害羞、不感兴趣，甚至不友好。
Despite wanting others to respond positively, people who are shy or socially anxious often exhibit nonverbal behaviors that communicate to others, “Stay away from me.” Examples of these closed nonverbal behaviors include leaning back or standing far away from other people, avoiding eye contact, speaking quietly, crossing your arms over your chest, clenching your fists, and maintaining a serious facial expression. Although you may believe that these behaviors serve as a form of protection in anxiety-provoking situations, they tend to have the opposite effect. 尽管渴望他人给予积极回应，害羞或社交焦虑的人往往会表现出一些非语言行为，向他人传达“离我远点”的信息。这些封闭的非语言行为的例子包括向后靠或站得远离他人、避免眼神接触、轻声说话、双臂交叉抱胸、握紧拳头以及保持严肃的面部表情。虽然你可能认为这些行为是在引发焦虑的情境中保护自己的一种方式，但它们往往产生相反的效果。
Instead of protecting you from potential threat or from being judged by others, these behaviors probably increase the likelihood that others will react negatively. For example, at a party, people are most likely to approach someone who is smiling, making eye contact, and talking at a reasonable volume. When someone stands far away, speaks quietly, and avoids eye contact, it is natural to assume that the individual is either uninterested in speaking or difficult to get to know. 这些行为不仅不能保护你免受潜在威胁或他人评判，反而可能增加他人负面反应的可能性。例如，在聚会上，人们最有可能接近那些微笑、进行眼神交流并以适当音量交谈的人。当有人站得很远、轻声说话并避免眼神接触时，人们自然会认为这个人要么对交谈不感兴趣，要么难以接近了解。
Of course, moderation is the key here. Too much eye contact can make others uncomfortable. In addition, someone who stands too close or smiles at inappropriate 当然，适度是关键。过多的眼神接触会让别人感到不舒服。此外，站得太近或在不合适的时候微笑，可能会让别人感到不安。
times may make others feel uneasy. Unfortunately, it is impossible to specify the appropriate intensity for each of these behaviors because so many variables play a role. What is appropriate in one situation is not necessarily appropriate in another. For example, although it’s okay to stand several inches away from a romantic partner during an intimate conversation, you probably would want to stand farther back when talking to a coworker. With respect to nonverbal communication, there are differences across gender and across cultures. Therefore, we suggest that you experiment with using different nonverbal behaviors to find out what works best for you in the particular situations that you encounter from day to day. 不幸的是，由于许多变量都会起作用，无法具体说明这些行为的适当强度。在一种情况下适当的行为，在另一种情况下未必合适。例如，虽然在与恋人进行亲密交谈时，站几英寸远是可以的，但与同事交谈时，你可能会想站得远一些。关于非语言交流，不同性别和文化之间存在差异。因此，我们建议你尝试使用不同的非语言行为，找出在你每天遇到的具体情境中最适合你的方式。
Closed nonverbal behaviors are behaviors that close the channels of communication by sending the message that the opportunity for contact or communication with you is unavailable. Below is a list of closed nonverbal behaviors often associated with social anxiety: 封闭的非语言行为是通过传递你不愿意接触或交流的信息，从而关闭交流渠道的行为。以下是一些常与社交焦虑相关的封闭非语言行为：
Leaning back while sitting (vs. leaning forward) 坐着时向后靠（与向前倾斜相对）
Standing far away from another person (vs. standing closer) 站得离另一个人很远（与站得更近相比）
Avoiding eye contact (vs. making appropriate eye contact) 避免眼神接触（与进行适当的眼神接触相比）
Speaking quietly (vs. speaking at a volume that is easily heard) 说话声音很小（与说话音量易于听见相比）
Crossing arms (vs. keeping arms uncrossed or making hand gestures) 双臂交叉（与保持双臂不交叉或做手势相比）
Maintaining a serious facial expression (vs. smiling warmly) 保持严肃的面部表情（与温暖微笑相对）
Speaking with a timid tone (vs. speaking with a confident tone) 用胆怯的语气说话（与自信的语气说话相对）
Sitting hunched over (vs. sitting up straight) 坐姿弯腰驼背（与坐姿挺直相对）
Exercise: Open Behaviors 练习：开放行为
Do you tend to overuse any of these behaviors? If so, try to replace some of your closed behaviors with open behaviors during the course of your exposure practices over the next week. Record your experiences in the provided space. For example, record whether people react differently to you when you smile more, make eye contact, or speak more loudly. 你是否倾向于过度使用以下某些行为？如果是，试着在接下来一周的暴露练习过程中，用开放行为替代一些封闭行为。请在提供的空间中记录你的体验。例如，记录当你更多地微笑、进行眼神交流或说话更大声时，人们是否对你的反应有所不同。
CONVERSATIONAL SKILLS 会话技巧
Do you often struggle to find things to say when making casual conversation or small talk? Do you keep quiet at parties or meetings because you find it difficult to contribute to conversations? When you do get involved in a conversation, perhaps you find that the discussion fizzles quickly, as you and the other person run out of things to say. In this section, we discuss ways of starting and ending conversations, as well as methods of improving the quality of your conversations. These suggestions may be adapted for different types of conversations, including talking to a coworker or classmate, conversing on a date, or speaking with a stranger while waiting in line. 你是否经常在进行日常交谈或闲聊时难以找到话题？你是否因为难以参与对话而在聚会或会议中保持沉默？当你参与对话时，是否发现讨论很快就冷场了，因为你和对方都找不到话题？本节将讨论如何开始和结束对话，以及提高对话质量的方法。这些建议可以适用于不同类型的对话，包括与同事或同学交谈、约会时交谈，或在排队时与陌生人交谈。
Keep in mind that the suggestions in this section are not always going to work smoothly. For example, if you start talking to someone in an elevator, the person may respond positively or may frown and ignore you. If an individual responds negatively when you try to make contact, remember that it’s not necessarily because you did something wrong. The other person may be shy or may be concerned about his or her safety (having been raised never to talk to strangers). Also, it’s possible that your communication will be misunderstood. If things don’t work out during a particular practice, try to understand why and to figure out what you can do differently next time. Learning from your experiences will help you to plan future practices that are more likely to work out satisfactorily. 请记住，本节中的建议并不总是能够顺利奏效。例如，如果你在电梯里开始和某人交谈，对方可能会积极回应，也可能会皱眉头并忽视你。如果当你试图建立联系时，对方反应消极，请记住这不一定是因为你做错了什么。对方可能是害羞，或者出于安全考虑（从小被教育不要和陌生人说话）。此外，你的交流也有可能被误解。如果某次练习没有成功，试着理解原因，并思考下次可以做些什么不同的事情。从经验中学习将帮助你规划未来更有可能取得满意效果的练习。
Finally, if you want to learn more about making conversation, we recommend that you read the third edition of Alan Garner’s book, Conversationally Speaking: Testing New Ways to Increase Your Personal and Social Effectiveness (1997). Another excellent book on improving conversation skills is Talk to Me: Conversation Tips for the Small-Talk Challenged (Honeychurch and Watrous 2003). 最后，如果你想了解更多关于如何进行对话的内容，我们推荐你阅读 Alan Garner 的第三版著作《Conversationally Speaking: Testing New Ways to Increase Your Personal and Social Effectiveness》（1997 年）。另一本关于提升对话技巧的优秀书籍是《Talk to Me: Conversation Tips for the Small-Talk Challenged》（Honeychurch 和 Watrous，2003 年）。
Starting a Conversation 开始一段对话
Although getting a conversation started is sometimes difficult, it often becomes easier with practice. Opportunities to start conversations are everywhere. For example, people often speak to strangers in grocery store lines and elevators, or on buses, subways, airplanes, and in other public places. People talk to others at parties, weddings, funerals, and work functions. If you are at a party, it is perfectly appropriate to walk up to a group of people who are already talking. After a minute or two of standing around with the group, you can join in the conversation. If you are a college student, you can increase your opportunities for casual conversation by always sitting in the same area of the classroom so you’ll have repeated exposure to some of the same students each time. Also, arrive to class early so you can chat with others before class starts. 虽然开始一段对话有时很困难，但通过练习通常会变得更容易。开始对话的机会无处不在。例如，人们经常在杂货店排队、电梯里，或者在公交车、地铁、飞机以及其他公共场所与陌生人交谈。人们在聚会、婚礼、葬礼和工作活动中也会与他人交谈。如果你在聚会中，走向一群已经在交谈的人是完全合适的。站在那群人旁边一两分钟后，你就可以加入对话。如果你是大学生，可以通过总是坐在教室的同一位置来增加随意交谈的机会，这样你每次都会遇到一些相同的同学。此外，提前到教室，这样你可以在上课前与他人聊天。
The topic of conversation should usually begin with something friendly and not too personal, particularly if you don’t know the other individual very well. You may begin with a question (something like, “How was your weekend?”), a compliment (“I like your new haircut”), an observation (perhaps, “I notice that you’re not driving your usual car”), 谈话的话题通常应以友好且不过于私人的内容开始，尤其是在你不太了解对方的情况下。你可以以一个问题开头（比如，“你周末过得怎么样？”）、一个赞美（“我喜欢你的新发型”）、或者一个观察（比如，“我注意到你没有开你平时的车”），
or an introduction (“I don’t believe we’ve met. My name is . . .”). Other appropriate topics include: hobbies, your job, a movie or TV show you recently saw, the weather, something you recently read, your vacation, a recent shopping trip or outing, and sports. After you’ve been talking for a while, it may be appropriate to discuss more controversial topics, such as politics, relationships, personal feelings, difficult family situations, and topics related to sexuality. However, you should introduce topics such as these slowly, and gauge the other person’s reactions before deciding how far to take the conversation. Try to avoid getting too personal, unless you know the other person well or the other person is disclosing similar types of personal information. At a party or on a first date, it’s fine to talk about your work or what your parents do for a living, but it is usually best to stay clear of weighty topics (like a past sexual assault, a recent history of depression, and so on). 或者自我介绍（“我想我们还没见过面。我叫……”）。其他合适的话题包括：爱好、你的工作、你最近看过的电影或电视节目、天气、你最近读过的东西、你的假期、最近的购物或外出经历，以及体育运动。聊了一会儿后，可能适合讨论一些更有争议的话题，比如政治、感情、个人感受、家庭困难情况以及与性相关的话题。然而，你应该慢慢引入这些话题，并观察对方的反应，再决定谈话的深度。尽量避免过于私人的话题，除非你很了解对方，或者对方也在透露类似的个人信息。在聚会或第一次约会时，谈论你的工作或你父母的职业是可以的，但通常最好避免涉及沉重的话题（比如过去的性侵经历、近期的抑郁史等）。
Improving the Quality of Your Conversations 提升你谈话质量的方法
Here are a few tips for improving your conversations: 以下是一些提升你谈话质量的建议：
Conversations are a two-way street. It’s not enough to just listen to another person. Nor is it appropriate to talk only about yourself without giving the other person a chance to speak. Of course, there are exceptions. There are some people who are very happy to have you do all the talking or allow them to do all the talking. However, for most of us, a conversation is far more interesting if we have the opportunity to express our own thoughts, feelings, and experiences and also the chance to listen to another person’s views and experiences. 对话是双向的。仅仅倾听对方是不够的，也不适合只谈论自己而不给对方发言的机会。当然，也有例外。有些人很乐意让你全程发言，或者让他们自己全程发言。然而，对大多数人来说，如果我们有机会表达自己的想法、感受和经历，同时也能听取对方的观点和经历，谈话会更加有趣。
Use active listening skills. The active listening skills described earlier in the chapter will enhance the quality of your conversations. In particular, be sure to reflect back that you are understanding what the other person is saying. 运用积极倾听技巧。本章前面描述的积极倾听技巧将提升你谈话的质量。特别要确保反馈你理解了对方所说的话。
Disclose some (but not too much) information about yourself. As mentioned earlier, the information you disclose should not be overly personal at first. Instead, you can start by talking about your weekend’s activities, your favorite sports team, a movie you recently saw, or a class that you’re taking, for example. 透露一些（但不要太多）关于你自己的信息。如前所述，你透露的信息一开始不应过于私密。你可以从谈论周末的活动、你喜欢的运动队、最近看过的一部电影，或者你正在上的一门课程开始。
Show interest in the other person. For instance, follow up what the other person says by asking for clarification or requesting more details. 表现出对对方的兴趣。例如，针对对方所说的话进行追问，要求对方澄清或提供更多细节。
Try a light touch. In some situations, it may be appropriate to touch the other individual (for example, a light touch on the arm). However, only use 尝试轻微的触碰。在某些情况下，适当触碰对方（例如，轻轻拍一下手臂）可能是合适的。然而，只在
touch if it can be done naturally, in a way that doesn’t seem overly forced. Note that the appropriate use of touch varies between men and women and across cultures. It may also be frowned on in professional settings. 能够自然进行且不显得过于勉强的情况下使用触碰。请注意，触碰的适当使用因男女和文化而异。在职业场合中，这种行为也可能不被认可。
Pay attention to detail. When telling stories, take your cues from others when trying to decide how much detail to include. See how detailed others are in their conversations, and model your own conversations after them. If you notice that others are starting to look bored or look at their watches while you tell a story, take that as a sign that it’s time to wrap it up. On the other hand, make sure your conversation is not completely devoid of details. Either too much detail or not enough detail can make a conversation less engaging. 注意细节。在讲故事时，根据他人的反应来决定包含多少细节。观察别人谈话时的细节程度，并以此为榜样调整自己的谈话内容。如果你发现别人开始显得无聊或看手表，这通常是该结束故事的信号。另一方面，也要确保你的谈话不是完全缺乏细节。过多或过少的细节都会使谈话变得不够吸引人。
Give and receive compliments. When complimenting others, make sure you are honest (don’t say you like something if you don’t), and don’t overdo it. Although it’s nice to receive a compliment from time to time, it can be uncomfortable to receive too many compliments or to receive compliments that are felt to be undeserved. If you receive a compliment from someone else, simply say thank you. Don’t discount the compliment or make the other person feel bad for giving it. 给予和接受赞美。当赞美他人时，确保你是真诚的（如果不喜欢某事，就不要说喜欢），并且不要过度。虽然偶尔收到赞美很愉快，但收到过多赞美或觉得赞美不配得时，可能会让人感到不舒服。如果你收到别人的赞美，只需说谢谢。不要贬低赞美，也不要让对方因为给予赞美而感到难堪。
Pay attention to your nonverbal behaviors. For example, make eye contact and speak so the other person can hear you. 注意你的非语言行为。例如，要保持眼神交流，并且说话时让对方能听清楚。
Asking Questions 提问技巧
Asking the other person questions will communicate that you are interested in what he or she has to say. You can ask about your conversation partner’s experiences (for example, “How was that restaurant you went to last night?”) or you can ask for the other person’s reaction to something you’ve said. If possible, try to use open-ended questions rather than closed-ended questions. A closed-ended question is one that elicits a response of only one or two words. For example, the closed-ended question “Did you like the movie?” could easily lead to responses like “Yes” or “No,” at which point you would be back at square one, trying to find another topic of conversation. Closed-ended questions usually begin with words like “are,” “do,” “who,” “when,” “where,” and “which.” 向对方提问会传达出你对他或她所说内容的兴趣。你可以询问谈话对象的经历（例如，“你昨晚去的那家餐厅怎么样？”），也可以询问对方对你所说内容的反应。如果可能，尽量使用开放式问题而非封闭式问题。封闭式问题通常只会得到一两个字的回答。例如，封闭式问题“你喜欢那部电影吗？”很可能只会得到“喜欢”或“不喜欢”的回答，这时你又回到了起点，得再找一个话题。封闭式问题通常以“是”、“做”、“谁”、“什么时候”、“哪里”和“哪个”等词开头。
In contrast, open-ended questions usually can elicit more detailed answers. Open-ended questions are more likely than closed-ended questions to generate longer and more interesting conversations. These types of question usually begin with words or phrases like “how,” “why,” and “in what way.” For example, the question “What did you think about the movie?” draws out a more thorough response than “Did you like the movie?” 相比之下，开放式问题通常能引出更详细的回答。开放式问题比封闭式问题更有可能引发更长且更有趣的对话。这类问题通常以“如何”、“为什么”和“以何种方式”等词或短语开头。例如，问题“你觉得那部电影怎么样？”比“你喜欢那部电影吗？”能引出更全面的回答。
Here are some examples of closed-ended and open-ended questions: 以下是一些封闭式和开放式问题的示例：
Closed-Ended Questions 封闭式问题
Open-Ended Questions 开放式问题
- Did you have a good weekend? - 你周末过得好吗？
-What did you do this weekend? - 你这个周末做了什么？
- Who is your favorite candidate? - 你最喜欢的候选人是谁？
- What do you like about the different candidates? - 你喜欢不同候选人的哪些方面？
-What do you do for a living? - 你是做什么工作的？
- How did you get into your current line of work? - 你是如何进入你目前的工作领域的？
- Do you like your psychology professor? - 你喜欢你的心理学教授吗？
- Why do you like your psychology professor? - 你为什么喜欢你的心理学教授？
Closed-Ended Questions Open-Ended Questions
- Did you have a good weekend? -What did you do this weekend?
- Who is your favorite candidate? - What do you like about the different candidates?
-What do you do for a living? - How did you get into your current line of work?
- Do you like your psychology professor? - Why do you like your psychology professor?| Closed-Ended Questions | Open-Ended Questions |
| :--- | :--- |
| - Did you have a good weekend? | -What did you do this weekend? |
| - Who is your favorite candidate? | - What do you like about the different candidates? |
| -What do you do for a living? | - How did you get into your current line of work? |
| - Do you like your psychology professor? | - Why do you like your psychology professor? |
Note that a question can be too open-ended, so that it is responded to as if it were a closed-ended question. For example, questions like “How are you?” or “How was your day?” typically lead to a one-word response such as “Fine.” 请注意，问题如果过于开放，可能会被当作封闭式问题来回答。例如，“你好吗？”或“你今天过得怎么样？”这类问题通常会得到一个单词的回答，比如“很好”。
Ending Conversations 结束对话
All conversations eventually come to an end. Furthermore, in informal social situations (at a party, on a date, on the phone), conversations almost always end because one or both people lose interest in what is being talked about or they reach a point at which they would rather be doing something else or talking to someone else. 所有对话最终都会结束。此外，在非正式的社交场合（如聚会、约会、打电话时），对话几乎总是因为一方或双方对谈话内容失去兴趣，或者他们到了更想做别的事情或与别人交谈的阶段而结束。
If you are especially sensitive to rejection, you may become more anxious as a conversation nears its end. Or you may be hurt if you think that the other person seems less interested in continuing to converse. Nevertheless, if you begin to pay attention to other people’s conversations, you will notice that all discussions reach a point at which there is little more to be said. Sometimes this point is reached in a few seconds. Other times, it may take a few minutes or even an hour for a particularly interesting conversation to end. Running out of things to talk about is not a failure and does not mean that you are boring. It is a normal feature of all conversations. 如果你对被拒绝特别敏感，当对话接近尾声时，你可能会变得更加焦虑。或者如果你觉得对方似乎不太想继续交谈，你可能会感到受伤。然而，如果你开始注意别人的对话，你会发现所有的讨论都会达到一个几乎无话可说的阶段。有时这个阶段几秒钟内就会到来，有时则可能需要几分钟，甚至一小时，尤其是当对话特别有趣时。话题聊尽并不是失败，也不意味着你很无聊。这是所有对话的正常特征。
Typically, people try to find graceful ways to get out of conversations that have run their course. At a party, you might excuse yourself to refill your drink or visit the bathroom. Or, it may be appropriate to mention politely that you need to catch up with another person at the party. In a work setting, people often end the conversation with a reference to work (for instance, “Well, I need to get back to work”) or a pledge to continue the conversation later (“Perhaps we can have lunch together some time soon”). Often, simply saying something like, “It’s been nice talking to you, but I need to run” is sufficient. If you have enjoyed the conversation, be sure to let your conversation partner know that (“I’ve really enjoyed talking to you. I hope we get a chance to talk again”). 通常，人们会寻找优雅的方式结束已经进行得差不多的对话。在聚会中，你可能会借口去续杯或上洗手间。或者，礼貌地提到你需要去和聚会上的另一位朋友聊聊也是合适的。在工作环境中，人们通常会以提到工作来结束对话（例如，“嗯，我得回去工作了”），或者承诺以后继续交流（“也许我们很快可以一起吃个午饭”）。通常，只要说类似“和你聊天很愉快，但我得走了”这样的话就足够了。如果你很享受这次对话，务必让对方知道（“我真的很喜欢和你聊天。希望我们有机会再聊”）。
Exercise: Conversations 练习：对话
Try using some of these conversational strategies the next time you’re having a conversation. If you rarely encounter situations that allow for conversation, you may need to go out of your way to seek out such situations. During the practice, pay special attention to using the strategies for starting the conversation, improving the quality of the conversation, and ending the conversation. In the spaces below, record your experiences after using the relevant strategies for each phase of the conversation. 下次你进行对话时，试着使用一些这些对话策略。如果你很少遇到可以进行对话的场合，可能需要特意去寻找这样的机会。在练习过程中，特别注意使用启动对话、提升对话质量和结束对话的策略。在下面的空白处，记录你在使用每个阶段相关策略后的体验。
Starting the conversation: 启动对话：
Improving the quality of the conversation: 提升对话质量：
Ending the conversation: 结束对话：
JOB INTERVIEWS 求职面试
Most people feel somewhat nervous when being interviewed for a job. In fact, showing no signs of anxiety could work against you in some interview situations. Not showing any signs of anxiety during an interview might be interpreted by the interviewer as a sign that you are overconfident or disinterested. But if you’re particularly anxious in social situations, interviews may be even more anxiety-provoking for you than they are for the average person. Chapter 6 reviewed strategies for changing the beliefs that contribute to your anxiety in situations such as interviews. Chapters 7 and 8 recommended practicing 大多数人在面试时都会感到有些紧张。事实上，在某些面试情况下，完全不表现出焦虑反而可能对你不利。面试中没有任何焦虑迹象，面试官可能会将其解读为你过于自信或缺乏兴趣。但如果你在社交场合特别焦虑，面试对你来说可能比普通人更令人紧张。第 6 章回顾了改变导致你在面试等情境中焦虑的信念的策略。第 7 章和第 8 章建议通过练习
exposure to interviews (using both real interview practices and role-play simulations) as a strategy for learning to become less anxious. In this section, we provide additional suggestions for improving interview skills. These suggestions are meant to be used along with the cognitive and exposure-based techniques discussed in earlier chapters. 面试暴露（包括真实面试练习和角色扮演模拟）作为学习减少焦虑的策略。在本节中，我们提供了更多提升面试技巧的建议。这些建议应与前几章讨论的认知和暴露技术结合使用。
Essentially, being prepared for an interview involves knowing what to do before the interview, how to behave during the interview, and what to do when the interview is over. We provide suggestions for each of these interview phases. For a more detailed discussion of this topic, we suggest reading Messages: The Communication Skills Book. There are several other excellent resources on interviewing for jobs listed in the recommended readings section at the end of this book. 本质上，准备面试包括了解面试前应做什么、面试中如何表现以及面试结束后应做什么。我们为这三个面试阶段提供了一些建议。关于这一主题的更详细讨论，建议阅读《信息：沟通技巧书》。本书末尾的推荐阅读部分还列出了几本关于求职面试的优秀资源。
Preparing for the Interview 准备面试
Here are some suggestions for preparing for an interview. These are all things to do before you get there: 以下是一些准备面试的建议。这些都是你到达面试地点之前需要做的事情：
Before the interview, practice interviewing with friends and family members. Also, practice interviewing for other jobs that are of less interest to you. As we discussed in chapters 7 and 8, practicing being interviewed will help to decrease your anxiety when you are in the actual situation. 面试前，与朋友和家人练习面试。同时，也可以练习面试那些你兴趣较小的职位。正如我们在第 7 章和第 8 章中讨论的，练习接受面试有助于减少你在实际面试中的焦虑。
Keep the situation in perspective. Remember that it’s only an interview. If it doesn’t work out, there will be other opportunities. Think of the interview as a learning experience or an opportunity to improve your interviewing skills. 保持对情况的正确认识。记住这只是一次面试。如果这次不成功，还会有其他机会。把面试看作一次学习经历或提升面试技巧的机会。
Take time to understand the purpose of the interview, learn who will be interviewing you, what the structure of the interview will be, and how long the interview will run. If possible, find out the interviewer’s name and make sure you remember it. If that’s not possible, when the interviewer introduces himself or herself to you, pay attention and try to use the name when you say good-bye. 花时间了解面试的目的，了解谁将面试你，面试的结构是什么，以及面试将持续多长时间。如果可能，弄清面试官的名字并确保记住。如果不可能，当面试官自我介绍时，要注意听，并尽量在告别时使用对方的名字。
Learn as much as possible about the organization or company and about the person who is interviewing you. If the organization has a website, make sure you study it carefully. You may even be able to learn about your interviewer beforehand. Being knowledgeable about the organization during the interview will show that you really are interested in the position. 尽可能多地了解该组织或公司以及面试你的人。如果该组织有网站，务必仔细研究。你甚至可能事先了解面试官的情况。在面试中对组织有充分了解，会显示你对该职位确实感兴趣。
Take some time to identify your strengths and have a good idea of what you can contribute to the organization, in case you’re asked. You may want to take some notes with you to prevent forgetting something that you want to mention. 花些时间识别你的优势，并清楚了解你能为组织贡献什么，以防有人问起。你可能想带些笔记，以免忘记想提及的内容。
Plan a response in case you are asked about your weaknesses or limitations. There is no need to list every flaw that comes into your mind. Instead, you can mention one or two limitations, phrasing them in such a way that they are unlikely to be viewed as a problem that cannot be solved. For example, you can choose to focus on a minor limitation in your experience or training that is unlikely to be viewed as serious. Or, you can deflect the question by talking about a limitation that you had in the past that is no longer a problem (something like, “When I first started my previous job, I didn’t have much experience working with computers. However, over the past few years, I got a lot of computer experience, so that’s not an issue anymore”). However, don’t emphasize limitations that could be viewed as weaknesses in your character or a reflection of your work habits (for example, “I get angry easily” or “I’m very unorganized”), since a potential employers may view these as harder to change. Also, avoid answering a question about your weaknesses with a response about how you work too hard (for instance, “I tend to work too hard, so I need to remind myself to take breaks”). This is a very cliché response that employers will see through (no employer would see that as a weakness). For more ideas on how to answer difficult interview questions, check out Ron Fry’s book, 101 Great Answers to the Toughest Interview Questions (2007). 提前准备好应对关于你弱点或不足的问题。无需列举脑海中想到的所有缺点。相反，你可以提及一两个不足，并以一种不太可能被视为无法解决的问题的方式来表达。例如，你可以选择强调你经验或培训中的一个小不足，这通常不会被视为严重问题。或者，你可以通过谈论过去曾有但现在已不成问题的不足来回避这个问题（比如，“刚开始上一份工作时，我对电脑操作经验不多，但这几年我积累了很多电脑经验，所以现在这不再是问题”）。不过，不要强调那些可能被视为性格缺陷或工作习惯问题的不足（例如，“我容易生气”或“我很不善于组织”），因为潜在雇主可能认为这些更难改变。同时，避免用“我工作太努力”来回答弱点问题（例如，“我往往工作过度，所以需要提醒自己休息”）。 这是一个非常陈词滥调的回答，雇主们很容易看穿（没有雇主会把这当作弱点）。想了解更多关于如何回答难题面试问题的思路，可以参考 Ron Fry 的书《101 个最棒的面试难题答案》（2007 年）。
Prepare at least ten questions you can ask during the interview. Write them down so you won’t forget. For example, you should consider asking questions about the types of responsibilities that you are likely to have, the hours you will be expected to work, who you will be working with, and the structure of a typical day. Questions about salary, vacations, and benefits generally should be asked after you have received an offer, although for certain positions it may be appropriate to ask these questions during the interview, particularly if the interviewer brings these topics up. 准备至少十个你可以在面试中提问的问题。把它们写下来，以免忘记。例如，你应该考虑询问你可能承担的职责类型、预期的工作时间、你将与谁共事以及典型工作日的结构。关于薪资、假期和福利的问题通常应在收到录用通知后再问，尽管对于某些职位，如果面试官主动提及这些话题，在面试中询问这些问题也是合适的。
Bring extra copies of your résumé and other supporting documents, in case the interviewer does not have easy access to these materials or wishes to share your résumé with someone else in the organization. 带上多份简历和其他支持材料，以防面试官无法方便地获取这些资料，或者希望与你的简历分享给组织中的其他人。
During the Interview 面试过程中
So, your interview day has arrived. Here are some suggestions for how to make the most of it: 所以，你的面试日到了。这里有一些建议，帮助你充分利用这一天：
Under no circumstances should you be late. Give yourself enough time to get to the interview and arrive a bit early. If you are unfamiliar with where the interview is being held, make sure to visit the site the previous day so you know how to get there. 无论如何都不要迟到。给自己足够的时间去面试地点，并提前一点到达。如果你不熟悉面试地点，确保前一天去实地查看，这样你就知道怎么去那里。
Your appearance is important. Make sure that you are dressed attractively and that your hair is neat. Note that appropriate attire for one job interview may be quite inappropriate for another type of job. If you’re not sure what to wear, err on the side of dressing in a more conservative and professional manner. 你的外表很重要。确保你穿着得体，头发整洁。注意，一份工作面试中合适的着装，可能对另一种工作来说完全不合适。如果你不确定穿什么，宁可选择更保守和专业的装扮。
Remember to use some of the strategies discussed earlier in this chapter. For example, really listen to what the interviewer asks or tells you. Pay attention to your nonverbal communication and try to maintain eye contact. 记得运用本章前面讨论过的一些策略。例如，认真听面试官的问题或陈述。注意你的非语言交流，尽量保持眼神交流。
Be courteous, polite, and tactful. Remember to say please and thank-you. Don’t disparage the organization, the interview process, or the person interviewing you. In fact, avoid appearing overly negative about previous jobs and employers, even if you were unhappy in a previous position. 要有礼貌、彬彬有礼且圆滑。记得说“请”和“谢谢”。不要贬低组织、面试过程或面试官。事实上，即使你对之前的工作不满意，也要避免表现出对以前的工作和雇主过于消极的态度。
Appear flexible and willing to compromise. For example, if the hours aren’t perfect, let the interviewer know that you will do what you can to accommodate the schedule. After you get the offer, you can renegotiate the hours. If it doesn’t work out to your satisfaction, you can always turn down the position. 表现出灵活和愿意妥协的态度。例如，如果工作时间不太理想，让面试官知道你会尽力配合时间安排。拿到录用通知后，你可以重新协商工作时间。如果最终安排不令你满意，你总是可以拒绝这份工作。
Ask questions. A job interview has two purposes: (1) to allow the interviewer to decide about you and (2) to give you an opportunity to decide whether you want to work for that particular organization. Make sure you ask questions during the interview. Not only will asking questions help you to find out more about the position, but it will also convey to the interviewer that you are serious about the job. 提出问题。面试有两个目的：（1）让面试官对你做出判断；（2）给你机会决定是否愿意为该组织工作。确保在面试过程中提出问题。提问不仅能帮助你更多了解职位，也会向面试官传达你对这份工作的认真态度。
In general, be yourself during the interview and answer questions honestly. However, don’t offer too much unnecessary personal information. For example, if the interviewer asks whether you are nervous, it’s okay to say that you are feeling a bit anxious. On the other hand, there is no need to provide details about any personal difficulties or stresses that you may be experiencing, including frequent panic attacks, depression, or marital problems. 一般来说，面试时要做自己，诚实回答问题。但不要提供过多不必要的个人信息。例如，如果面试官问你是否紧张，可以说你有点焦虑。另一方面，没有必要透露你可能正在经历的任何个人困难或压力，包括频繁的恐慌发作、抑郁或婚姻问题。
At the end of your interview, ask the interviewer what the next steps are. For example, if the organization will be interviewing other candidates, when can you expect to hear their decision? Is there likely to be a second or third interview for the finalists? 面试结束时，询问面试官下一步的安排。例如，该机构是否还会面试其他候选人？你什么时候可以期待他们的决定？决赛入围者是否可能会有第二轮或第三轮面试？
After the Interview 面试结束后
Your work isn’t quite over once the interview ends. Here are a couple of suggestions for things to do after the interview has ended: 面试结束后，你的工作还没有完全结束。以下是面试结束后可以做的几件事的建议：
After the interview, send a letter thanking the interviewer for his or her time. 面试结束后，发送一封感谢信，感谢面试官抽出时间。
Take some time to think about what went well during the interview and what you might have preferred to do or say differently. This information will be helpful for planning your next set of interviews if you don’t get the job. 花些时间思考面试中表现良好的地方，以及你可能希望以不同方式做或说的内容。如果你没有得到这份工作，这些信息将有助于你为下一轮面试做准备。
ASSERTIVE COMMUNICATION 自信沟通
This section describes three ways of communicating: passive communication, aggressive communication, and assertive communication. Passive and aggressive styles of communication rarely have the desired effect; assertive communication is more likely to get positive results. This section will help you to understand the differences among these three types of communication and will provide you with an introduction to methods for ensuring that you communicate assertively. 本节介绍三种沟通方式：被动沟通、攻击性沟通和自信沟通。被动和攻击性的沟通方式很少能达到预期效果；自信沟通更有可能获得积极的结果。本节将帮助你理解这三种沟通类型之间的区别，并为你介绍确保自信沟通的方法。
Passive Communication 被动沟通
Generally, shyness and social anxiety are associated with a tendency to communicate passively. Passive communication involves expressing one’s needs indirectly, often in a quiet voice, and perhaps with frequent pauses and hesitations. Passive communication places the other person’s wants, needs, and desires ahead of your own. This style of communicating is often associated with a strong desire to avoid any possibility of offending or inconveniencing the other individual. However, because your message is not communicated directly, the other person may never receive the message that you intended to communicate. Therefore, passive communication closes the channels of communication and may cause you to feel hurt and resentful. In fact, this resentment eventually may put you at risk for communicating in an aggressive manner later on. For example, a passive way of inviting someone to socialize is the vague statement, “We should get together sometime.” 通常，害羞和社交焦虑与被动沟通倾向相关。被动沟通指的是间接表达自己的需求，通常声音较轻，且可能伴有频繁的停顿和犹豫。被动沟通将对方的愿望、需求和欲望置于自己的前面。这种沟通方式通常与强烈避免冒犯或给对方带来不便的愿望有关。然而，由于你的信息没有直接传达，对方可能永远无法接收到你想要传达的信息。因此，被动沟通关闭了沟通渠道，可能导致你感到受伤和怨恨。事实上，这种怨恨最终可能使你在以后以攻击性的方式进行沟通。例如，以被动方式邀请某人社交的模糊说法是：“我们应该找时间聚一聚。”
Aggressive Communication 攻击性沟通
Aggressive communication involves expressing your feelings, needs, or wants at the expense of another’s feelings, needs, and wants. Aggressive communication tends to be judgmental, critical, and accusatory in content and tone. Like passive communication, this style of responding closes the channels of communication and can result in hurt feelings, grudges, anger, and alienation from the other person. An example of an aggressive way of asking someone to socialize is the statement, “If you cared about me and weren’t so selfish, you would invite me to get together with you more often.” 攻击性沟通是指在表达自己的感受、需求或愿望时，牺牲他人的感受、需求和愿望。攻击性沟通的内容和语气往往带有评判性、批评性和指责性。与被动沟通类似，这种回应方式会关闭沟通渠道，可能导致受伤的感情、积怨、愤怒以及与对方的疏远。一个以攻击性方式邀请别人社交的例子是：“如果你在乎我，不那么自私，你就会更经常邀请我一起聚会。”
Assertive Communication 自信沟通
Often, people assume that passive and aggressive styles of communicating are their only two options. However, there is a third option. In contrast to aggressive and passive styles of communicating, assertive communication takes into account one’s own feelings, needs, and wants, as well as those of the other person. Assertive communication has many of the features of good communication, including a tendency to be direct, clear, and immediate. An example of an assertive way to invite someone to socialize is the question, “Would you like to see a movie with me this weekend?” 人们常常认为被动和攻击性沟通是他们唯一的两种选择。然而，还有第三种选择。与攻击性和被动沟通方式相反，自信沟通既考虑自己的感受、需求和愿望，也考虑对方的感受、需求和愿望。自信沟通具有许多良好沟通的特征，包括倾向于直接、清晰和及时。一个以自信方式邀请别人社交的例子是：“你这个周末想和我一起去看电影吗？”
In addition, assertive communication should include actively listening to the other person’s perspective (including trying to hear and understand the other person’s point of view, validating the other person’s feelings, asking for clarification, and so on). Although assertive communication does not guarantee that you will get your way, compared with aggressive and passive styles of communication, assertive statements are more likely to keep the channels of communication open and to maximize the chances of reaching a mutually satisfactory resolution. 此外，果断的沟通应包括积极倾听对方的观点（包括尝试听取并理解对方的观点，认可对方的感受，询问澄清等）。虽然果断的沟通不能保证你一定能如愿以偿，但与攻击性和被动的沟通方式相比，果断的表达更有可能保持沟通渠道畅通，并最大化达成双方满意解决方案的机会。
Dealing Assertively with Conflict Situations 果断应对冲突情境
If your goal is to convince someone else to change his or her behavior, an appropriate way of doing that is to make sure that your message is neither passive nor aggressive. Instead, you should try to communicate your message in a way that is factual, direct, and empathic. 如果你的目标是说服别人改变其行为，合适的方式是确保你的信息既不被动也不具攻击性。相反，你应尝试以事实、直接且富有同理心的方式传达你的信息。
Begin by describing your observations regarding the situation. Observations reflect your perspective regarding the facts, rather than your interpretations of those facts. Observations should be based on reality and therefore are usually very difficult to argue with. For example, “You arrived home too late” is not an observation because whether the person’s arrival is “too” late is open to interpretation. However, the statement “You arrived home an hour later than you said you would” is an observation (assuming it’s true) and is therefore less likely to lead to a defensive response from the other person. 首先描述你对情况的观察。观察反映的是你对事实的看法，而不是你对这些事实的解释。观察应基于现实，因此通常很难被反驳。例如，“你回家太晚了”不是观察，因为“太晚”是否成立是可以解释的。然而，“你比说好的时间晚了一个小时回家”是一种观察（假设这是真的），因此不太可能引起对方的防御反应。
After describing your observations, the next step is to describe your feelings about the situation. Feelings are emotions such as anger, anxiety, worry, and sadness. Feelings are not thoughts. For example, the statement “I feel that you should not be late” is not really a feeling statement. In contrast, “I feel hurt and worried when you arrive home later than you say you will” is a feeling statement. As is the case with communicating your observations, it’s difficult to argue with a feeling statement. Only you know how you really feel. 在描述完你的观察后，下一步是描述你对情况的感受。感受是诸如愤怒、焦虑、担忧和悲伤等情绪。感受不是想法。例如，“我觉得你不应该迟到”并不是真正的感受陈述。相反，“当你比说好的时间晚回家时，我感到受伤和担忧”才是感受陈述。与表达观察一样，感受陈述也很难被反驳。只有你自己知道你真正的感受。
Finally, it is important to communicate the ways in which you would like things to change. To follow the earlier example through, you might say, “I would like you to phone me if you are going to be more than thirty minutes late.” 最后，重要的是要表达你希望事情如何改变。以之前的例子为例，你可以说：“如果你要迟到超过三十分钟，请给我打电话。”
After you communicate your message in terms of these three components, you need to make sure that you give the other person a chance to express his or her perspective on the situation. Make sure you take advantage of the active listening skills that were discussed earlier in this chapter. 在你用这三个部分传达你的信息后，你需要确保给对方一个机会，让他或她表达对情况的看法。务必利用本章前面讨论过的积极倾听技巧。
In addition to these basic assertiveness skills, there are a number of other strategies that may help you to deal with conflict situations: 除了这些基本的自信表达技巧外，还有许多其他策略可能帮助你应对冲突情境：
Make sure that you choose an appropriate time to talk about the situation. Don’t put it off indefinitely. On the other hand, don’t talk about the issue during the height of your anger. Also, don’t insist that the issue be discussed right away if the other person is busy or unwilling to talk. Sometimes it’s best to schedule a meeting at a mutually convenient time and to discuss the matter then. 确保选择一个合适的时间来谈论这个情况。不要无限期拖延。另一方面，也不要在你愤怒的高峰期讨论这个问题。此外，如果对方忙碌或不愿意谈论，不要坚持立即讨论。有时最好安排一个双方都方便的时间，然后再讨论此事。
Make sure that you challenge the beliefs that contribute to your anxiety, anger, or hurt feelings. As discussed in chapter 6, our feelings are influenced by our beliefs, and our beliefs may be exaggerated or unrealistic at times. In other words, the situation may not matter as much as you think it does. When discussing the situation with the other person, try to maintain your cool by thinking about the situation realistically. 确保挑战那些导致你焦虑、愤怒或受伤感受的信念。正如第 6 章所讨论的，我们的情绪受信念影响，而我们的信念有时可能被夸大或不切实际。换句话说，情况可能没有你想象的那么重要。在与对方讨论情况时，试着通过现实地看待情况来保持冷静。
Before confronting a situation, decide whether it is worth it. Is it a situation that matters? Will it take care of itself, even if you don’t say anything? For example, if your difficult neighbor is moving away next week, perhaps it’s not important to complain about the way he or she maintains the lawn. 在面对某种情况之前，先决定它是否值得。这个情况重要吗？即使你什么都不说，它会自行解决吗？例如，如果你那个难相处的邻居下周要搬走，也许抱怨他或她如何打理草坪并不重要。
Try bouncing your thoughts off a neutral third party. Hearing another person’s views regarding the issue may help you to see things in a different way. This can be particularly useful to determine whether your expectations about the situation are distorted. 试着把你的想法告诉一个中立的第三方。听听别人对这个问题的看法，可能会帮助你以不同的角度看待事情。这对于判断你对情况的期望是否有偏差尤其有用。
Try to understand the other person’s perspective. Like you, the other individual is just trying to survive the best way that he or she can. Hostility and anger often are triggered by feelings of threat or hurt. If you develop an empathic understanding of the other person’s perspective and beliefs, you will have a greater chance of finding a compromise and resolving the conflict, particularly if the other person can see that you are genuinely trying to understand. 试着理解对方的视角。和你一样，另一个人也只是尽力以他或她能做到的最好方式生存。敌意和愤怒往往是由威胁感或受伤感引发的。如果你能培养对对方视角和信念的同理理解，你将更有可能找到妥协并解决冲突，尤其是当对方看到你真诚地试图理解时。
Consider writing a letter to the other person. Sometimes it’s easier to communicate your thoughts and feelings in writing. However, even in a letter, you should use an assertive communication style rather than a passive or aggressive one. It is usually best not to use e-mail in these situations. 考虑给对方写一封信。有时候，用书面形式表达你的想法和感受会更容易。然而，即使是在信中，你也应该使用自信的沟通方式，而不是被动或攻击性的方式。在这些情况下，通常最好不要使用电子邮件。
MEETING NEW PEOPLE, MAKING FRIENDS, AND DATING 结识新朋友、交朋友和约会
This section describes ways of improving the skills that are important for meeting new people and developing new relationships. The topics covered include suggestions for where to meet new people and ways to deal with certain stresses associated with developing relationships, such as the possibility of being rejected. 本节介绍了提升结识新朋友和发展新关系所需技能的方法。涵盖的主题包括建议在哪里结识新朋友，以及如何应对与发展关系相关的某些压力，比如被拒绝的可能性。
Places to Meet New People 结识新朋友的场所
In a survey of more than 3,000 Americans, Laumann, Gagnon, Michael, and Michaels (1994) studied the ways and places in which people meet. Among married people, the ways that individuals met their spouses are shown by percentages as follows: 在对 3000 多名美国人进行的一项调查中，Laumann、Gagnon、Michael 和 Michaels（1994）研究了人们相识的方式和地点。在已婚人士中，个体认识配偶的方式按百分比显示如下：
Way of Meeting 相识方式
Percent* 百分比*
Introduction by a friend 朋友的介绍
35%35 \%
Introduction by self 自我介绍
32%32 \%
Introduction by a family member 家庭成员的介绍
15%15 \%
Introduction by a coworker 同事的介绍
6%6 \%
Introduction by a classmate 同学的介绍
6%6 \%
Introduction by someone else 他人的介绍
2%2 \%
Introduction by a neighbor 邻居的介绍
1%1 \%
Way of Meeting Percent*
Introduction by a friend 35%
Introduction by self 32%
Introduction by a family member 15%
Introduction by a coworker 6%
Introduction by a classmate 6%
Introduction by someone else 2%
Introduction by a neighbor 1%| Way of Meeting | Percent* |
| :--- | :--- |
| Introduction by a friend | $35 \%$ |
| Introduction by self | $32 \%$ |
| Introduction by a family member | $15 \%$ |
| Introduction by a coworker | $6 \%$ |
| Introduction by a classmate | $6 \%$ |
| Introduction by someone else | $2 \%$ |
| Introduction by a neighbor | $1 \%$ |
*Note: The numbers do not add up to 100 percent because a small number of people gave multiple answers. *注：数字之和未达到 100%，因为少数人给出了多个答案。
In the same survey, the places where married individuals met their spouses were broken down into percentages as follows: 在同一项调查中，已婚人士遇见配偶的地点按百分比细分如下：
Location of Meeting 相遇地点
Percent 百分比
School 学校
23%
Work 工作
15%
Party 聚会
10%
Place of worship (e.g., church) 礼拜场所（例如，教堂）
8%
Bar 酒吧
8%
Gym or social club 健身房或社交俱乐部
4%
Personal ad 个人广告
1%
Vacation 度假
1%
Elsewhere 其他地方
30%
Location of Meeting Percent
School 23%
Work 15%
Party 10%
Place of worship (e.g., church) 8%
Bar 8%
Gym or social club 4%
Personal ad 1%
Vacation 1%
Elsewhere 30%| Location of Meeting | Percent |
| :--- | :--- |
| School | 23% |
| Work | 15% |
| Party | 10% |
| Place of worship (e.g., church) | 8% |
| Bar | 8% |
| Gym or social club | 4% |
| Personal ad | 1% |
| Vacation | 1% |
| Elsewhere | 30% |
The statistics were similar for people in unmarried partnerships (couples cohabiting, couples in long-term partnerships, and couples in short-term partnerships), although some of the numbers were different in these other groups. For example, compared with married people, unmarried people in short-term relationships were more likely to have met their partners at a bar ( 17 percent) or a party ( 25 percent) and less likely to have met them at a place of worship ( 1 percent). Note that this survey was conducted before the Internet boom, so it doesn’t include information about online dating. We will return to this topic shortly. 未婚伴侣（同居情侣、长期伴侣和短期伴侣）的人群统计数据类似，尽管这些群体中的某些数字有所不同。例如，与已婚人士相比，处于短期关系中的未婚人士更有可能在酒吧（17%）或派对（25%）上认识他们的伴侣，而在宗教场所认识伴侣的比例较低（1%）。请注意，这项调查是在互联网兴起之前进行的，因此不包含关于网络约会的信息。我们稍后会回到这个话题。
There are many other locations where it can be relatively easy to develop new friendships or to meet a potential partner. Some examples include the following: through a hobby (for example, joining a photography club or a theater group), getting involved in a sport (joining a bowling league, a running club, or a hiking group), getting in shape (for instance, lifting weights in a gym, joining an aerobics class, taking swimming lessons), taking dance classes, volunteering for an organization, forming a book club or reading group, attending public lectures, taking a part-time job, enrolling in an adult education course, or traveling (perhaps with a group). 还有许多其他地方相对容易结交新朋友或遇见潜在伴侣。一些例子包括：通过兴趣爱好（例如，加入摄影俱乐部或戏剧团体）、参与体育运动（加入保龄球联赛、跑步俱乐部或徒步旅行团）、锻炼身体（例如，在健身房举重、参加有氧运动课程、学习游泳）、参加舞蹈课程、为某个组织做志愿者、组建读书俱乐部或读书小组、参加公开讲座、做兼职工作、报名成人教育课程，或者旅行（也许是跟团旅行）。
The best way to meet new people is to do the things that you enjoy doing. That way, you are likely to meet people who enjoy the same things you do. For example, if you don’t enjoy drinking alcohol or spending time in bars, you should think twice about trying to meet people there. At a bar, you are likely to meet people who enjoy going to bars. You should also keep in mind the types of people you are likely to meet by getting involved in a particular activity. For example, if you want to meet people close to your own age, try to get involved in activities that attract people in your age group. 结识新朋友的最好方式是做你喜欢做的事情。这样，你更有可能遇到和你有相同兴趣的人。例如，如果你不喜欢喝酒或待在酒吧里，那么你应该三思而后行，不要试图在那里认识人。在酒吧里，你很可能遇到喜欢去酒吧的人。你还应该考虑通过参与某项活动可能遇到的人的类型。例如，如果你想认识与你年龄相仿的人，试着参与吸引你这个年龄段人的活动。
It’s not enough just to be around other people. To meet them, it will be necessary to take social risks in the situation. For openers, you should maintain eye contact, make a point of saying hello, and be sure to smile from time to time. Casual contact is more likely to develop into a friendship or relationship if you purposely engage in conversation. As you get to know someone, you will need to take bigger risks such as asking that person to meet you for coffee, go to a movie, or join you for a day’s outing to a park or a museum. 仅仅和别人待在一起是不够的。要真正认识他们，你需要在社交场合中冒一定的风险。首先，你应该保持眼神交流，主动打招呼，并且时不时地微笑。如果你有意识地进行交谈，随意的接触更有可能发展成友谊或关系。当你逐渐了解某人时，你需要冒更大的风险，比如邀请对方一起喝咖啡、看电影，或者一起去公园或博物馆游玩一天。
Meeting People Online 在线认识人
Internet dating is a very popular way to meet people. The Internet Dating Guide (www theinternetdatingguide.com) reports that about 30 percent of American singles have used matchmaking sites. According to Online Dating Magazine (www.onlinedating magazine.com), twenty million Americans visit an online dating service each month, 120,000 marriages per year occur as a result of an online dating service, and about a third of Americans know someone who has used an online dating service. The Internet is also a great source of information about ways for singles to meet. Simply enter the name of your city and the word “singles” into a search engine (for example, Google), and you 网络约会是结识新人的一种非常流行的方式。《网络约会指南》（www.theinternetdatingguide.com）报告称，大约 30%的美国单身人士使用过配对网站。根据《在线约会杂志》（www.onlinedatingmagazine.com），每个月有两千万美国人访问在线约会服务，每年有 12 万对通过在线约会服务结婚，约三分之一的美国人认识使用过在线约会服务的人。互联网也是单身人士获取结识方式信息的绝佳来源。只需在搜索引擎（例如 Google）中输入你所在城市的名称和“单身”一词，你
will likely come up with all sorts of ideas, ranging from “speed dating” groups to singles travel opportunities, personal ad listings, and social events. 很可能会找到各种各样的想法，从“快速约会”小组到单身旅行机会、个人广告列表以及社交活动。
In addition to online dating, the Internet is a popular way to meet new friends. An anonymous survey of 191 college students (Knox et al. 2001) found that friendship (as opposed to dating) was the most important reason for using the Internet among this group. In this survey, 60 percent of respondents reported that they had successfully established an online friendship, and about half reported being more comfortable meeting people online than in person. However, note that 40 percent of people reported having lied online! More recently, online social networking sites like Facebook.com and MySpace.com have become popular ways to meet friends. 除了网络约会，互联网也是结识新朋友的流行方式。一项对 191 名大学生的匿名调查（Knox 等，2001 年）发现，友谊（而非约会）是这群人使用互联网的最重要原因。在这项调查中，60%的受访者表示他们成功建立了网络友谊，约有一半的人表示在网上认识人比面对面更自在。然而，需要注意的是，有 40%的人承认曾在网上撒谎！最近，像 Facebook.com 和 MySpace.com 这样的在线社交网站已成为结交朋友的流行方式。
It is important for you not to use online relationships as a replacement for in-person relationships. Rather, you should view online relationships as a stepping stone toward meeting people in person. The recommended readings section at the end of the book provides additional resources on online dating. 重要的是，你不要将网络关系作为面对面关系的替代品。相反，你应将网络关系视为迈向面对面认识人的垫脚石。本书末尾的推荐阅读部分提供了关于网络约会的更多资源。
Dating Skills 约会技巧
Regardless of how it may seem, there are lots of potential partners out there, regardless of whether you are old or young, male or female. Furthermore, the idea that there is only one person out there who is your soul mate is a myth. There are many different people who are potentially excellent partners, each having very different qualities to bring to a relationship. Although it may sound like a cliché, it is often true that someone comes along when you least expect it, and often it occurs when you’re not even looking. So relax. Rushing the process can lead to feelings of disappointment or failure when a hoped-for relationship doesn’t work out. There are several excellent published guides to dating, a number of which are listed in the recommended readings at the end of the book. 无论看起来如何，无论你是年长还是年轻，男性还是女性，外面都有很多潜在的伴侣。此外，只有一个人是你灵魂伴侣的想法是一个误区。实际上，有许多不同的人可能成为优秀的伴侣，每个人都能为关系带来截然不同的品质。虽然这听起来像陈词滥调，但通常有人会在你最意想不到的时候出现，而且往往是在你根本没有寻找的时候。所以放轻松。匆忙进入关系可能会导致当期望的关系未能实现时产生失望或失败感。市面上有几本优秀的约会指南，本书末尾的推荐阅读中列出了一些。
PREPARATION 准备
The first step in dating is preparation. What does preparation in this context mean? It means you figure out what you’re looking for. What is the purpose of your search? Are you looking for a serious relationship, marriage, and children? Or are you looking for a sexual partner? Companionship? A way to alleviate boredom? The purpose of the relationship will influence what kind of person you will seek and attract. For example, if you are looking for excitement, meeting someone who is aloof, mysterious, and gorgeous may be your aim. On the other hand, if you want a more serious relationship, you should choose to emphasize qualities that will continue to be important to you after the thrill of a new relationship wears off, like a sense of humor, shared values, kindness, honesty, stability, responsibility, and respect. 约会的第一步是准备。在这个语境中，准备是什么意思？它意味着你要弄清楚自己在寻找什么。你寻找的目的是什么？你是在寻找一段认真的关系、婚姻和孩子吗？还是你在寻找一个性伴侣？陪伴？一种消除无聊的方式？关系的目的会影响你会寻找和吸引哪种类型的人。例如，如果你在寻找刺激，遇见一个冷漠、神秘且迷人的人可能是你的目标。另一方面，如果你想要一段更认真的关系，你应该选择强调那些在新关系的激情消退后仍然对你重要的品质，比如幽默感、共同的价值观、善良、诚实、稳定、责任感和尊重。
Despite the saying “opposites attract,” the cliché “birds of a feather flock together” is probably closer to the truth. Generally, research in social psychology has found that 尽管有“异性相吸”的说法，但“物以类聚”这个陈词滥调可能更接近事实。一般来说，社会心理学的研究发现
people are most attracted to those who are similar to them with respect to values, appearance, interests, and other attributes. Being aware of your own interests and attributes will help you to know what you are looking for in another person. In addition, being the type of person who you would like to meet will help you to attract that person. To meet the right person, you need to make a point of being in places where that person is likely to be. For example, if you’re interested in meeting someone who loves reading, then make a point of spending time in the library, visiting bookstores, or attending book signings. 人们最容易被那些在价值观、外貌、兴趣和其他特质上与自己相似的人所吸引。了解自己的兴趣和特质将帮助你知道自己在另一个人身上寻找什么。此外，成为你希望遇见的那种人，也会帮助你吸引到那个人。要遇见合适的人，你需要刻意去那些那个人可能出现的地方。例如，如果你想认识一个喜欢阅读的人，那么就要刻意花时间待在图书馆、逛书店或参加签书会。
NETWORKING 社交网络
One very helpful activity for meeting new people is called networking. Networking can be defined as an exchange of information or services among individuals or groups. As we mentioned earlier, more than two thirds of married people are introduced to their spouses by a third person (Laumann et al. 1994). Therefore, let your friends and family know that you are interested in meeting someone. If nothing romantic develops, you may add to your circle of friends. By adding new friends (without actually giving up on old friendships), you will increase your chances of finding a partner. 一种非常有助于结识新朋友的活动叫做社交网络。社交网络可以定义为个人或群体之间的信息或服务交换。正如我们之前提到的，超过三分之二的已婚人士是通过第三者介绍认识配偶的（Laumann 等，1994）。因此，让你的朋友和家人知道你有兴趣认识新朋友。如果没有发展成浪漫关系，你也可能会扩大你的朋友圈。通过增加新朋友（而不放弃旧友谊），你将增加找到伴侣的机会。
FIRST DATES 初次约会
When you do meet someone who interests you, the initial date can be quite informal. For example, you might go for a walk during a break at work, run an errand together between classes, or offer the person a ride home. After you’ve had more contact with the person, you could suggest a more formal outing, like going out for lunch or dinner, seeing a concert or movie, or visiting a gallery or museum. If you are a student, you might suggest taking a class with the other person to increase your chances of having repeated contact. 当你遇到感兴趣的人时，初次约会可以相当随意。例如，你们可以在工作休息时一起散步，课间一起跑个腿，或者顺路送对方回家。在你们有更多接触之后，可以建议更正式的活动，比如一起吃午餐或晚餐，去听音乐会或看电影，或者参观画廊或博物馆。如果你是学生，可以建议和对方一起选修一门课程，以增加反复接触的机会。
On your date, pay attention to small details, especially your physical appearance and hygiene. Dress appropriately for the situation. Wear clothes you like, but err on the side of conservative or classic fashions if you are unsure about the other person’s taste. In other words, don’t wear your most outrageous outfit on a first date. 在约会时，注意小细节，尤其是你的外表和个人卫生。根据场合穿着得体。穿你喜欢的衣服，但如果不确定对方的品味，最好选择保守或经典的款式。换句话说，第一次约会时不要穿你最夸张的服装。
REJECTION 拒绝
Be prepared for rejection. Much more often than not, a particular dating situation does not lead to a long-term relationship. It’s normal for one person to be more interested in pursuing a relationship than the other person is. If the other individual ends up not wanting to continue the relationship, make sure that you keep the rejection in perspective (see chapter 6 for suggestions). A rejection does not mean that there is something wrong with you or that going out on dates will never lead to a long-term relationship. Rather, rejection speaks more to the fit between you and the specific person with whom things didn’t work out. Experiencing some form of rejection is a necessary part of dating. The more dating experiences you seek out, the more rejection you will 要做好被拒绝的准备。大多数情况下，某次约会并不会发展成长期关系。一个人对发展关系的兴趣往往比另一个人更强烈是很正常的。如果对方最终不想继续这段关系，一定要保持理性看待被拒绝的事实（有关建议请参见第 6 章）。被拒绝并不意味着你有问题，或者约会永远不会带来长期关系。相反，被拒绝更多地反映了你和那个特定对象之间的匹配度不合适。经历某种形式的拒绝是约会过程中必不可少的一部分。你寻求的约会经历越多，被拒绝的次数也会越多。
experience. However, increasing the frequency of your dates will also provide opportunities to improve your dating skills and increase the likelihood of developing a positive relationship in the future. 经验。然而，增加约会的频率也会提供更多机会来提升你的约会技巧，并增加未来发展积极关系的可能性。
PRESENTATIONS AND PUBLIC SPEAKING SKILLS 演讲与公众演说技巧
This section provides a basic primer on public speaking and giving presentations. In particular, it includes suggestions for preparing for presentations or talks and describes ways to improve the quality of your presentations. 本节提供了关于公众演说和演讲的基础入门知识。特别是，它包括准备演讲或报告的建议，并描述了提升演讲质量的方法。
For a more detailed treatment of this topic, we suggest that you check out the recommended readings on public speaking at the end of this book. Although the emphasis in most of these books is on business presentations, many of the skills suggested apply to other types of presentations as well, such as giving a speech at a wedding or party. In addition to providing suggestions for how to organize and deliver presentations, most of these recommended books also provide ideas for managing anxiety during presentations. One that provides an excellent mix of information on presentation skills and managing anxiety is The Confident Speaker: Beat Your Nerves and Communicate at Your Best in Any Situation (Monarth and Kase 2007). 关于这一主题的更详细内容，我们建议你查阅本书末尾推荐的公众演讲相关读物。尽管这些书籍大多侧重于商务演讲，但其中许多技巧同样适用于其他类型的演讲，比如在婚礼或聚会上发表演讲。除了提供如何组织和呈现演讲的建议外，大多数推荐书籍还提供了管理演讲焦虑的思路。其中一本在演讲技巧和焦虑管理方面结合得非常好的是《自信的演讲者：克服紧张，在任何场合发挥最佳表现》（Monarth 和 Kase，2007）。
Preparing for Presentations 准备演讲
Preparing for presentations involves seven important steps: (1) identifying the purpose of the presentation, (2) determining the nature of the audience, (3) deciding upon the subject matter, (4) organizing the presentation, (5) making your talk interesting and compiling supporting materials, (6) rehearsing the presentation, and (7) managing your anxiety. 准备演讲包括七个重要步骤：（1）确定演讲的目的，（2）了解听众的性质，（3）决定主题内容，（4）组织演讲结构，（5）使演讲内容有趣并收集支持材料，（6）排练演讲，以及（7）管理你的焦虑。
STEP 1: DETERMINING THE PURPOSE OF THE PRESENTATION 步骤一：确定演讲的目的
Before preparing a lecture or speech, you must first be clear about the purpose of the presentation. Essentially, presentations can have one or more of the following functions: 在准备讲座或演讲之前，你必须首先明确演讲的目的。基本上，演讲可以具有以下一种或多种功能：
To persuade. For example, a presentation may be designed to sell a particular product or to convince a group of coworkers to change a procedure in the workplace. 说服。例如，一场演讲可能旨在推销某个特定产品，或说服一群同事改变工作场所的某项程序。
To explain. Examples include a half-day orientation meeting to explain company procedures to new employees, a lecture designed to teach a complex topic to college students, or a seminar to provide in-depth information to colleagues about a particular subject. 解释。例子包括为新员工举办的半天公司程序介绍会，为大学生讲授复杂主题的讲座，或为同事提供某一特定主题深入信息的研讨会。
To instruct. These may include presentations regarding how to perform a task (like how to use a new computer program) or how to develop a new skill (for example, learning to dance). 指导。这些可能包括关于如何执行某项任务（如如何使用新电脑程序）或如何培养新技能（例如学习跳舞）的演讲。
To brief. Some presentations are designed to brief an audience regarding some matter. For example, this may include a four-minute presentation to update management about the status of union negotiations or to brief your customers about changes in the price of a product. 简报。有些演讲旨在向听众简要介绍某些事项。例如，这可能包括一场四分钟的演讲，向管理层汇报工会谈判的进展情况，或向客户简要说明产品价格的变动。
To entertain. Examples of presentations designed to entertain include theatrical presentations (for instance, stand-up comedy) and sometimes speeches at weddings, anniversaries, or parties. 娱乐。旨在娱乐的演讲示例包括戏剧表演（例如，单口喜剧）以及有时在婚礼、周年纪念或聚会上发表的演讲。
STEP 2: DETERMINING THE NATURE OF THE AUDIENCE 第二步：确定观众的性质
Before planning a presentation in detail, it is helpful to know something about the nature of your audience. In some cases, you may even need to ask the audience questions about their background at the start of the presentation and adapt your style or content to meet their needs. Some questions that are helpful to consider include the following: 在详细规划演讲之前，了解观众的性质是有帮助的。在某些情况下，你甚至可能需要在演讲开始时向观众提问，了解他们的背景，并调整你的风格或内容以满足他们的需求。一些有助于考虑的问题包括：
How big is the audience? 观众有多大规模？
What is the likely composition of the audience (factors such as age, gender, professional background)? 观众的可能构成是什么（如年龄、性别、职业背景等因素）？
What is the audience expecting? 观众期待什么？
How much does the audience already know? What do they still need to learn? 观众已经知道多少？他们还需要学习什么？
Why is the audience attending the presentation-because they have to or because they want to? 观众为什么参加演讲——是因为必须参加还是因为想参加？
STEP 3: DECIDING UPON THE SUBJECT MATTER 步骤三：确定主题内容
Before giving your presentation, you should have an idea of the main message that you want to convey. In most cases, the main point of the presentation should be simple and clear. The audience should be aware of the key points that you plan to make so that the content of the presentation can be understood in the proper context. In most cases, it’s helpful to pique the group’s interest (perhaps with a joke, anecdote, or illustration) early in the talk. If the purpose of your presentation is to persuade the audience about some issue, you should ensure that you have gained their confidence (for example, by making the members of the audience aware of your expertise and credentials). Also, persuasive presentation should include specific instructions on how to implement the suggestions you provide (for example, where to obtain the product you are selling). 在进行演讲之前，你应该对想要传达的主要信息有一个清晰的认识。在大多数情况下，演讲的重点应当简明清晰。听众应当了解你计划提出的关键点，这样才能在适当的语境中理解演讲内容。通常，在演讲开始时激发听众的兴趣（例如通过笑话、轶事或示例）是有帮助的。如果你的演讲目的是说服听众接受某个观点，你应确保赢得他们的信任（例如，让听众了解你的专业知识和资历）。此外，说服性的演讲应包含具体的实施建议（例如，告诉听众如何获得你所推销的产品）。
STEP 4: ORGANIZING THE PRESENTATION 步骤四：组织演讲内容
One of the most common suggestions made to people who prepare presentations is to pay close attention to the three phases of the talk: the introduction, the main body of the talk, and the conclusion. The introduction should include an overview of the presentation so audience members know what to expect. The main body of the presentation is where you discuss the main content of the talk, with all of the important details. At the conclusion, you should provide a brief summary, as well as some interpretations and inferences about the content (for instance, why the presentation was important). 给准备演讲的人最常见的建议之一是密切关注演讲的三个阶段：引言、演讲主体和结论。引言应包括演讲的概述，让听众知道可以期待什么。演讲主体是你讨论演讲主要内容的部分，包含所有重要细节。在结论部分，你应提供简要总结，以及对内容的一些解释和推断（例如，为什么这次演讲很重要）。
If possible, your presentation should be organized so it tells a story. For example, before describing a new method of performing some task, you might provide the audience with a history of how that particular task has been performed in the past so they have a context in which to understand the new information. Or, the presentation can be laid out so that a series of problems are described, each followed by one or more solutions. 如果可能，你的演讲应组织成一个故事。例如，在描述执行某项任务的新方法之前，你可以向听众介绍该任务过去是如何完成的，这样他们就有了理解新信息的背景。或者，演讲可以安排成先描述一系列问题，然后分别提出一个或多个解决方案。
STEP 5: MAKING THE PRESENTATION INTERESTING 步骤 5：使演讲更有趣
In addition to making sure your main points are conveyed to the audience, it is important that they are conveyed in a way that is interesting. To help you do this, consider strategies like humor, analogies, personal stories, examples, illustrations, and relevant statistics. Be careful not to use humor that could offend audience members. You never know who is in your audience and whether their backgrounds, beliefs, or experiences might cause them to take a joke the wrong way. Another strategy is to involve the audience members in some way. For example, you might ask them questions or encourage them to ask you questions during your presentation. Or you could have them do something (demonstrate the skill you are trying to teach, complete a survey or take a test, and so on). Supporting materials can be another useful way to bring your presentation to life. 除了确保你的主要观点传达给观众外，还要确保传达的方式有趣。为此，你可以考虑使用幽默、类比、个人故事、例子、插图和相关统计数据等策略。注意不要使用可能冒犯观众的幽默。你永远不知道观众中有哪些人，他们的背景、信仰或经历是否会让他们误解某个笑话。另一种策略是以某种方式让观众参与进来。例如，你可以在演讲中向他们提问，或鼓励他们向你提问。你也可以让他们做一些事情（演示你想教的技能、完成调查或参加测试等）。辅助材料也是让你的演讲生动起来的另一种有效方式。
Supporting materials. Supporting materials often take the form of visuals (for example, PowerPoint slides and other projected images, videos, white boards, flip charts, CD ROMs, and so on). These visuals can include text, photos, illustrations, cartoons, graphics, and maps. Here are a few suggestions to keep in mind regarding supporting materials: 辅助材料。辅助材料通常以视觉形式出现（例如，PowerPoint 幻灯片和其他投影图像、视频、白板、翻页图表、光盘等）。这些视觉材料可以包括文本、照片、插图、漫画、图形和地图。以下是关于辅助材料的一些建议：
If you are going to use cartoons, make sure they are funny. Ask some friends, family members, or coworkers for their opinions about the cartoons you intend to use. 如果你打算使用漫画，确保它们是有趣的。可以请一些朋友、家人或同事对你打算使用的漫画发表意见。
In some cases, it may be helpful to have props. For example, if you mention particular books in your presentation, have copies with you for audience members to look at. If you are describing a product, bring it with you and display it during the presentation. 在某些情况下，使用道具可能会有帮助。例如，如果你在演讲中提到特定的书籍，带上几本供观众查看。如果你在描述某个产品，带上实物并在演讲中展示。
If possible, provide handouts containing copies of your slides and overheads so that audience members can listen to you instead of having to take notes. Audience members generally appreciate getting handouts. 如果可能，提供包含幻灯片和投影片复印件的讲义，这样观众可以专心听讲，而不必忙于记笔记。观众通常会很感激收到讲义。
Make sure that your slides and overheads are attractive and that the type is large enough to be seen from the back of the room. 确保你的幻灯片和投影片具有吸引力，且字体足够大，以便从教室后排也能看清。
Avoid the temptation to have too much information on your slides and overheads. 避免在幻灯片和投影片上放置过多信息的诱惑。
STEP 6: REHEARSING THE PRESENTATION 步骤 6：演练演讲
If at all possible, rehearse your presentation beforehand. There are several ways of rehearsing. Ideally, you can rehearse in front of an audience of friends, family, or coworkers, preferably in a location similar to where the actual talk will be held. Ask your rehearsal audience for feedback, and make changes to the presentation accordingly. If you cannot rehearse in front of a live audience, try rehearsing in front of a video camera or camcorder and watch the recording afterward. If that’s not possible, practice out loud in front of a mirror. As you become more experienced in giving presentations, practicing beforehand will become less important. 如果可能的话，事先演练你的演讲。有几种演练方式。理想情况下，你可以在朋友、家人或同事面前演练，最好是在与实际演讲地点相似的环境中。请你的演练观众提供反馈，并据此对演讲内容进行调整。如果无法在现场观众面前演练，试着在摄像机或录像机前演练，然后观看录制内容。如果这也不可能，就在镜子前大声练习。随着你演讲经验的增加，事先练习的重要性会逐渐降低。
STEP 7: MANAGING YOUR ANXIETY 步骤 7：管理你的焦虑
Preparing for a presentation should also include strategies for managing your anxiety. Before the presentation, make sure that you have used the cognitive strategies (chapter 6) to challenge your anxious thoughts. In addition, use the exposure-based strategies (chapters 7 through 9) to confront your fears whenever possible. When you’re actually in the situation, make sure that your breathing is slow and regular. Overbreathing or holding your breath will increase your anxiety symptoms. Don’t fight your fear. Just let the symptoms happen. Fighting your fear is likely to cause anxiety symptoms to intensify. It’s okay to be nervous during a presentation. In fact, audience members often expect it. Depending on the nature of the presentation, it may even be helpful to tell the audience you are feeling nervous. Saying so may help you to calm down, and it very likely will help to win the audience over to your side. 准备演讲时，也应包括管理焦虑的策略。在演讲前，确保你已经使用了认知策略（第 6 章）来挑战你的焦虑想法。此外，尽可能使用基于暴露的策略（第 7 至 9 章）来面对你的恐惧。当你真正处于演讲情境中时，确保你的呼吸缓慢且规律。过度呼吸或屏住呼吸会加重你的焦虑症状。不要与恐惧抗争。只需让症状自然发生。抗争恐惧很可能会使焦虑症状加剧。演讲时紧张是正常的，事实上，听众通常也会预期你会紧张。根据演讲的性质，告诉听众你感到紧张甚至可能有帮助。这样说可能帮助你冷静下来，也很可能帮助你赢得听众的支持。
Delivering the Presentation 进行演讲
Here is a list of suggestions to keep in mind when you are giving a presentation. 以下是在你进行演讲时需要记住的一些建议。
Pay attention to the way you deliver your speech. Before the talk, check any pronunciations you’re not sure about. Make sure that your voice does not drop off at the end of your sentences. Be sure you are projecting at a reasonable volume (imagine you are delivering your speech to the back wall 注意你演讲的方式。演讲前，检查你不确定的发音。确保你的声音在句子结尾时不会减弱。确保你的音量适中（想象你是在对着后墙演讲）。
of the room). Speak crisply and pronounce your words clearly. Avoid saying “uh” and “um.” Finally, avoid speaking too quickly. Going too fast is one of the most common mistakes people make during presentations, particularly when they are feeling anxious. （房间的）说话要清晰，发音要准确。避免说“呃”和“嗯”。最后，避免说得太快。说得太快是人们在演讲时最常犯的错误之一，尤其是在感到紧张时。
Make eye contact with the audience members during the talk. 在演讲过程中与观众保持眼神交流。
Try to move around when you are speaking. Walk around the front of the room rather than staying planted at a podium. Don’t put your hands in your pockets. Instead, gesture with your hands to emphasize key points. However, keep your hands away from your face and hair. 说话时尽量多走动。不要一直站在讲台上，而是在房间前面走动。不要把手放进口袋。相反，用手势来强调关键点。但要避免手触碰脸部和头发。
Presentations are often less interesting when they are read verbatim. If you read a presentation word for word, you also run the risk of panicking if you lose your place. Instead, we recommend speaking from a detailed outline with lots of headings, bullets, and so on. An outline will make sure that all the information you need is available and easy to access, even if you lose your place. It will also force you to be somewhat spontaneous during the presentation. If the thought of not reading your speech is too scary, another option is to bring both an outline version and a fully written version. If necessary, you can switch to reading your presentation if using the outline alone doesn’t work. 当演讲逐字朗读时，通常会显得不那么有趣。如果你逐字朗读演讲稿，一旦忘词还可能会慌乱。相反，我们建议你根据一个详细的大纲来演讲，大纲中应包含大量标题、要点等内容。大纲能确保你所需的所有信息都触手可及，即使你忘词也能迅速找到位置。它还会促使你在演讲中保持一定的即兴发挥。如果不读稿的想法让你感到害怕，另一种选择是同时准备一个大纲版本和一个完整的书面版本。如果仅用大纲不奏效，你可以在必要时切换到朗读演讲稿。
Don’t talk down to your audience. They probably know more than you think they do. Even if the material is new to them, they will not appreciate being talked to like children-unless, of course, they are children! Make sure your tone of voice and the things you say are not condescending. 不要对听众居高临下地讲话。他们可能比你想象的更有见识。即使内容对他们来说是新的，他们也不会喜欢被当作小孩子一样对待——当然，除非他们真的是小孩子！确保你的语气和所说的话不带有居高临下的意味。
Repeat the main points of the presentation frequently. Audience members will not hear everything you say, and if they miss an important point you may lose them for the rest of the presentation unless the important points are repeated. 经常重复演讲的要点。听众不会听到你说的所有内容，如果他们错过了一个重要点，除非你重复这些重要点，否则你可能会失去他们对演讲的关注。
Keep it simple. Don’t try to discuss more than your time allows. 保持简洁。不要试图讨论超过你时间允许的内容。
Make sure you are prepared to handle questions. Consider bringing additional information (a reference book, notes, and so on) that may be needed to answer certain types of questions. No matter how silly a question is, try to answer it tactfully and show respect for the person who asked the question (for example, “That’s an interesting question . . .”). Finally, repeat all audience questions before you answer them. Chances are good that people in the back of the room will not be able to hear some of the questions the first time they are asked. 确保你准备好应对提问。考虑带上可能需要用来回答某些类型问题的额外资料（参考书、笔记等）。无论问题多么愚蠢，都要尽量得体地回答，并尊重提问者（例如，“这是一个有趣的问题……”）。最后，在回答之前重复所有听众的问题。很可能坐在后排的人第一次听到问题时听不清。
Be yourself during the talk. Audiences prefer a speaker who is down to earth and genuine rather than someone who looks as if he or she is trying too hard to be entertaining or to impress the audience. 在演讲中做自己。听众更喜欢脚踏实地、真诚的演讲者，而不是看起来过于努力想要娱乐或给观众留下深刻印象的人。
After the Presentation 演讲结束后
Following your presentation, it is helpful to evaluate the quality of your performance, basing your evaluation on whether you followed the suggestions provided in this chapter. Don’t base your self-evaluation on whether you were anxious during the presentation or whether your anxiety symptoms showed. The presenter’s anxiety or lack thereof is only one small aspect of what makes an effective presentation. 在演讲结束后，评估你的表现质量是有帮助的，评估应基于你是否遵循了本章提供的建议。不要根据你在演讲过程中是否感到焦虑或是否表现出焦虑症状来进行自我评价。演讲者的焦虑与否只是构成有效演讲的众多因素中的一个小方面。
Social anxiety is associated with the tendency to be an overly harsh critic of one’s own performance. Therefore, we suggest that you obtain objective feedback from your audience members as well. This can be done informally by asking people what they thought of the talk. Or, if appropriate, it can be done more formally by handing out an anonymous evaluation form that requires audience members to rate their impressions of certain aspects of the presentation, such as the format of the presentation, the content (for example, interest level, relevance, difficulty, and so on), the speaker (for example, presentation skills, organization, expertise, clarity), use of audiovisual resources, and the location (for instance, lighting, temperature, seating comfort). In addition, make sure to include space on the form for audience members to write their impressions (strengths of the presentation, areas for improvement) in their own words. 社交焦虑通常伴随着对自己表现过于苛刻的倾向。因此，我们建议你也从听众那里获得客观反馈。这可以通过非正式的方式进行，比如询问人们对演讲的看法。或者，如果合适的话，也可以通过发放匿名评价表的更正式方式进行，要求听众对演讲的某些方面进行评分，比如演讲的形式、内容（例如，兴趣程度、相关性、难度等）、演讲者（例如，演讲技巧、组织能力、专业知识、表达清晰度）、视听资源的使用以及场地（例如，照明、温度、座椅舒适度）。此外，确保在表格上留有空间，让听众用自己的话写下他们的印象（演讲的优点、需要改进的地方）。
CHAPTER 11 第 11 章
Maintaining Your Improvements and Planning for the Future 保持你的进步并规划未来
Abstract 摘要
The purpose of this final chapter is to discuss strategies for ensuring that the gains you have made so far are maintained over the coming months and years. Perhaps the most important suggestion we can offer is that you should continue to use the strategies described in the first ten chapters. Continuing to use approaches that were helpful in getting you to where you are now will ensure that you maintain your gains and that your anxiety continues to decrease over time. 本章的目的是讨论确保你迄今为止取得的进步在未来几个月乃至几年内得以维持的策略。也许我们能提供的最重要建议是，你应继续使用前十章中描述的策略。持续使用那些帮助你达到现状的方法，将确保你保持已有的进步，并使你的焦虑随着时间的推移持续减少。
THE END OF TREATMENT 治疗结束
In some ways, treatment is never finished. Although most people experience improvements using the strategies described in this book, it’s common for people to continue to suffer from anxiety in some social situations from time to time. Like back pain, depression, and high blood pressure, anxiety is often a chronic problem that comes and goes, but it can also be controlled. It will be helpful for you to continue to use the methods described in this book to make sure that your anxiety doesn’t worsen. In fact, an important goal of cognitive behavioral therapy is to teach people to be their own therapists. If this book has been effective, chances are that your anxiety is much better than it was and you have learned some strategies that you can continue to use as you move forward. 在某种程度上，治疗永远不会真正结束。虽然大多数人使用本书中描述的策略后会有所改善，但人们仍然常常在某些社交场合中偶尔感到焦虑。就像背痛、抑郁和高血压一样，焦虑通常是一种反复发作的慢性问题，但它也是可以被控制的。你继续使用本书中描述的方法，将有助于确保你的焦虑不会恶化。事实上，认知行为疗法的一个重要目标就是教会人们成为自己的治疗师。如果这本书对你有效，那么你的焦虑很可能比以前好多了，并且你已经学会了一些可以在今后继续使用的策略。
If treatment has been less effective than you would have liked, this is a time to figure out why. Here are some possible reasons to consider: 如果治疗效果不如你所愿，现在是时候找出原因了。以下是一些可能需要考虑的原因：
Inadequate dosage. Typically, we think of dosage in the context of medication treatments, and certainly an inadequate dosage of medication (taking too little medication or taking medication for too short a time) can lead to a lack of improvement. However, the term “dosage” can also be applied to cognitive behavioral strategies. There is evidence that improvement is directly related to the amount of homework a person completes. So, if your exposure practices are too short or too infrequent or you don’t practice challenging your anxiety-provoking thoughts, your anxiety may not have improved as much as you had hoped. 剂量不足。通常，我们在药物治疗的语境中考虑剂量，确实，药物剂量不足（服用药物过少或服用时间过短）可能导致疗效不佳。然而，“剂量”一词也可以应用于认知行为策略。有证据表明，改善程度与一个人完成的作业量直接相关。因此，如果你的暴露练习时间过短或频率过低，或者你没有练习挑战引发焦虑的想法，你的焦虑可能没有达到预期的改善效果。
Stress. If you were under a lot of stress while working on the strategies in this book, you may have found only limited benefit. For example, if you were working very long hours, dealing with family stresses, or coping with serious health problems, you may not have been able to devote as much time to this treatment as you might have liked. Our recommendation is to try again once the stress in your life has subsided. Stress can also lead to a return of fear, an issue to which we will return shortly. 压力。如果你在使用本书中的策略时承受了很大压力，可能只获得了有限的益处。例如，如果你工作时间非常长，处理家庭压力，或应对严重的健康问题，可能无法投入足够的时间进行治疗。我们的建议是，在生活中的压力减轻后再尝试。压力也可能导致恐惧的复发，这个问题我们稍后会再讨论。
Other psychological problems. In some cases, shyness and social anxiety are part of another problem. For example, someone with an eating disorder may have high levels of social anxiety for fear of looking fat in front of others. Although the strategies in this book may help in such a case, it would also be important to directly address the eating issues. 其他心理问题。在某些情况下，害羞和社交焦虑是另一种问题的一部分。例如，患有饮食失调的人可能因为害怕在别人面前显得胖而有很高的社交焦虑水平。虽然本书中的策略可能在这种情况下有所帮助，但同时直接解决饮食问题也很重要。
Other life issues. For some people, years of social anxiety can lead to various long-term problems, including chronic unemployment, extreme loneliness, severe depression, or substance-use problems. Without addressing these larger issues, the strategies described in this book may not have much impact on improving your overall quality of life. It will be important to find some help and support for these larger issues as well. Chapter 4 includes some recommendations for finding a therapist. Professional help may be able to steer you in a direction toward solving these other problems in addition to your anxiety. 其他生活问题。对于一些人来说，多年的社交焦虑可能导致各种长期问题，包括长期失业、极度孤独、严重抑郁或物质使用问题。如果不解决这些更大的问题，本书中描述的策略可能对改善整体生活质量影响不大。找到帮助和支持来应对这些更大问题也非常重要。第四章中包含了一些寻找治疗师的建议。专业帮助可能不仅能帮助你缓解焦虑，还能引导你朝着解决其他问题的方向前进。
WHY FEAR RETURNS AND WHAT YOU CAN DO ABOUT IT 恐惧为何会复发以及你能做些什么
Most people who receive treatment for social anxiety experience long-lasting improvements in their anxiety, particularly following cognitive and behavioral treatment. 大多数接受社交焦虑治疗的人在焦虑方面都会有持久的改善，尤其是在认知和行为治疗之后。
Nevertheless, there are a number of different reasons why fear may return for some individuals. If your fear returns, the best thing to do is to resume using the strategies that were most helpful to you the first time you overcame your fear. Social anxiety that comes back sometime after a period of improvement may even be easier to overcome the second time around. 尽管如此，对于某些人来说，恐惧感可能会因多种不同原因而重新出现。如果你的恐惧感再次出现，最好的做法是重新使用那些在你第一次克服恐惧时最有效的策略。社交焦虑在一段时间的改善后再次出现，第二次克服起来甚至可能更容易。
Discontinuing the Treatment Strategies Too Early or Too Quickly 过早或过快停止治疗策略
Discontinuing your cognitive therapy and exposure practices may increase the likelihood of experiencing a return of fear, particularly if you stop using these techniques before you have completely overcome your anxiety. We recommend that you continue to challenge your anxiety-provoking thoughts from time to time for as long as you continue to feel anxious. When your fear has decreased significantly, you can stop using the cognitive diaries. However, you should continue to use the cognitive techniques informally, by silently asking yourself appropriate questions (for example, “Is there some other, nonanxious way of interpreting this situation?”). 过早停止认知疗法和暴露练习可能会增加恐惧感复发的可能性，尤其是在你尚未完全克服焦虑时停止使用这些技巧。我们建议你在仍感到焦虑的情况下，继续不时挑战那些引发焦虑的想法。当你的恐惧感显著减轻后，可以停止使用认知日记。然而，你应继续非正式地使用认知技巧，通过默默地问自己适当的问题（例如，“有没有其他不焦虑的方式来解读这种情况？”）来帮助自己。
In addition, you should take advantage of opportunities to expose yourself to previously feared situations even after your fear has been reduced. Sometimes life circumstances (such as being busy at work or school, or recovering from the flu) make it hard to practice exposure on a regular basis. Whenever possible, continue to confront your feared situations from time to time. Occasional exposures should help to prevent your fear from returning. 此外，即使你的恐惧已经减轻，也应抓住机会让自己暴露在之前害怕的情境中。有时生活状况（例如工作或学校繁忙，或正在从流感中恢复）会使得定期进行暴露练习变得困难。只要有可能，仍应不时面对你害怕的情境。偶尔的暴露有助于防止恐惧的复发。
Stopping medication too early may also increase the risk of your anxiety returning. As discussed in chapter 5, relapse following discontinuation from treatment with antidepressants is believed to be less likely when treatment has continued for at least a year. So, it’s best not to stop medication treatment the moment you start to feel better. 过早停止用药也可能增加焦虑复发的风险。如第五章所述，抗抑郁药治疗至少持续一年后停药，复发的可能性被认为较低。因此，最好不要在刚开始感觉好转时就停止药物治疗。
Coming off medication suddenly may also increase the risk of your fear returning. Discontinuation from some antidepressants and from almost all anti-anxiety medications is associated with symptoms of withdrawal, which often mimic the symptoms of anxiety. These withdrawal symptoms may prompt some people to resume their old habits of avoidance and fearful thinking. The best way of preventing withdrawal symptoms following discontinuation from medication is to reduce the dosage very slowly over time. We strongly recommend that you not reduce or stop your medication without first consulting with your doctor. 突然停药也可能增加恐惧感复发的风险。停用某些抗抑郁药和几乎所有抗焦虑药物时，常会出现戒断症状，这些症状往往与焦虑症状相似。这些戒断症状可能促使一些人恢复以往的回避行为和恐惧思维。预防停药后戒断症状的最佳方法是逐渐缓慢地减少药物剂量。我们强烈建议您在未先咨询医生的情况下，不要自行减少或停止用药。
Life Stresses 生活压力
Sometimes, an increase in the stress in your life can lead to a return of anxiety and fear. For example, if you experience a stressful life event (increased hours at work, 有时，生活中的压力增加可能会导致焦虑和恐惧的复发。例如，如果你经历了一个压力大的生活事件（工作时间增加，
relationship problems, financial difficulties, health problems, family tensions, death of a close friend, and the like), you may find that your anxiety in social situations gets worse. Sometimes, this worsening of anxiety occurs while the stress is ongoing; other times it may occur shortly after the stress has ended. 关系问题、经济困难、健康问题、家庭紧张、亲密朋友去世等情况，可能会导致你在社交场合中的焦虑加重。有时，这种焦虑加重会在压力持续期间发生；有时则可能在压力结束后不久出现。
The relationship between stress and increased social anxiety is not surprising. Most people respond to stress in characteristic ways. Some tend to respond physically by experiencing more colds, headaches, increased blood pressure, and other physical ailments. Others may fall into bad habits, such as smoking more, increasing alcohol or caffeine consumption, eating unhealthy foods, or exercising less. Still others may respond emotionally by becoming more anxious, depressed, or irritable. If your natural pattern has been to experience anxiety in social situations, stress may cause some of your old responses to resurface. 压力与社交焦虑增加之间的关系并不令人惊讶。大多数人以特有的方式应对压力。有些人倾向于通过身体反应表现出来，比如感冒、头痛、血压升高以及其他身体疾病。还有些人可能会养成不良习惯，比如吸烟增多、饮酒或咖啡因摄入增加、饮食不健康或减少锻炼。还有些人可能会情绪化地反应，变得更加焦虑、抑郁或易怒。如果你天生在社交场合容易感到焦虑，压力可能会使你的一些旧有反应重新出现。
Stress tends to increase a person’s arousal level, so breathing becomes heavier, heart rate increases, and other symptoms of arousal become more intense. When you’re under stress, it doesn’t take much change in your anxiety level for the feeling to become more noticeable than usual. Situations that are normally okay may seem overwhelming when you are experiencing other stresses in your life. 压力往往会提高一个人的唤醒水平，因此呼吸变得更重，心率加快，其他唤醒症状也会更加明显。当你处于压力之下时，焦虑水平稍有变化，感觉就会比平时更为明显。平时还算可以应对的情境，在你生活中经历其他压力时，可能会显得难以承受。
Most of the time, the increase in social anxiety following stress is temporary; when the stress level improves, the anxiety decreases again. However, if you respond to your increased anxiety by falling back into your old habits of anxious thinking and avoidance behaviors, you may find that the increased social anxiety continues even after the stress has passed. If your anxiety returns following a stressful life event, the best thing to do is to reread the relevant sections of this book and resume using some of the strategies that you found helpful the first time around. 大多数情况下，压力引发的社交焦虑增加是暂时的；当压力水平改善时，焦虑也会随之减轻。然而，如果你在焦虑加剧时又回到以往焦虑思维和回避行为的老习惯中，你可能会发现即使压力过去了，社交焦虑仍然持续存在。如果在经历压力事件后焦虑再次出现，最好的做法是重新阅读本书相关章节，并重新使用你第一次觉得有帮助的一些策略。
Encountering a New and Unexpectedly Difficult Situation 遇到新的且出乎意料的困难情境
Although you may think you have overcome a particular fear, it is possible that some fear remains but that you just haven’t had a chance to encounter a sufficiently challenging situation until now. One of our clients was recently surprised to experience intense fear while unexpectedly having to give a toast at his father’s birthday party. He had worked very hard to overcome his fear of public speaking at work. After a few months of practice, he found he could speak comfortably in meetings, and he even gave long presentations to groups of 200 or more with almost no fear. One day, he was asked on the spur of the moment to make a toast at his father’s birthday party to about thirty friends and relatives whom he had known his whole life. This made him very nervous. Although he had successfully overcome his fear of speaking in formal work situations, he had never had the opportunity to speak in an informal and personal situation like a family party. For him, giving a toast in front of friends and relatives was actually a new situation that he hadn’t had the chance to practice previously. 虽然你可能认为自己已经克服了某种恐惧，但实际上可能仍然存在一些恐惧，只是你直到现在还没有遇到足够具有挑战性的情境。我们的一位客户最近在他父亲的生日聚会上意外地不得不发表祝酒词时，感到强烈的恐惧，这让他感到很惊讶。他曾非常努力地克服了在工作中公开演讲的恐惧。经过几个月的练习，他发现自己可以在会议中自如发言，甚至能在 200 人以上的群体面前做长时间的演讲，几乎没有恐惧感。一天，他被临时要求在父亲的生日聚会上向大约三十位他一生中认识的朋友和亲戚敬酒。这让他非常紧张。虽然他成功克服了在正式工作场合演讲的恐惧，但他从未有机会在像家庭聚会这样非正式且私人的场合发言。对他来说，在朋友和亲戚面前敬酒实际上是一个新的情境，他之前没有机会练习过。
Experiencing a Trauma in the Feared Situation 在恐惧情境中经历创伤
Sometimes, experiencing a trauma in a social situation can lead to a return of fear. For example, if your audience during a presentation is particularly cold and unfriendly, if you are rejected by someone whom you care about, or if your boss is extremely critical of your performance in a meeting, you may find that you’re more anxious the next time you return to the situation. The fact that you had a particular anxiety in the past makes it more likely that it will return if you experience a negative event in a situation that mirrors this old fear. 有时，在社交场合经历创伤会导致恐惧感的复发。例如，如果你在演讲时遇到的观众特别冷漠且不友好，或者你被一个你在意的人拒绝，或者你的老板在会议上对你的表现极为苛刻，你可能会发现下次再次面对类似情境时会更加焦虑。你过去曾有过特定的焦虑，这使得如果你在类似的情境中经历了负面事件，这种焦虑更有可能再次出现。
If you experience a negative event in a situation that you previously feared, the best thing to do is to return to the situation as soon as possible. If you begin to avoid the situation, your anxiety will be more likely to return. In addition to exposure, try challenging your anxious beliefs by considering alternative, nonanxious interpretations of the negative event you experienced. 如果你在一个你以前害怕的情境中经历了负面事件，最好的做法是尽快回到那个情境中。如果你开始回避这个情境，你的焦虑更可能会复发。除了暴露疗法之外，尝试通过考虑你所经历的负面事件的其他非焦虑的解释，来挑战你焦虑的信念。
PREVENTING YOUR FEAR FROM RETURNING 防止恐惧复发
Although your anxiety is unlikely to return after you have learned to be more comfortable in social and performance situations, there are no guarantees. Nevertheless, there are a number of things that you can do to improve your chances of maintaining your gains. 虽然在你学会在社交和表演场合中更加自如后，你的焦虑不太可能再次出现，但这并不能保证绝对不会复发。尽管如此，你仍然可以采取一些措施来提高保持成果的机会。
Continue to Use the Cognitive Therapy and Exposure Strategies 继续使用认知疗法和暴露策略
As we’ve discussed, continuing to challenge your anxious thoughts informally and to practice exposure from time to time will help you to maintain the improvements that you have made so far. We also recommend that you reread relevant sections from this book occasionally to reinforce what you have learned and to make sure that you haven’t forgotten any important principles. 正如我们所讨论的，继续非正式地挑战你的焦虑想法，并不时练习暴露，将有助于你维持迄今为止取得的进步。我们还建议你偶尔重读本书中相关章节，以巩固所学内容，并确保没有遗忘任何重要原则。
Practice Exposure in a Range of Situations and Contexts 在各种情境和环境中练习暴露
Your gains are likely to last longer if you practice exposure in a wide variety of situations and contexts. For example, if you’re fearful of starting conversations, rather than practicing starting conversations only at work, we recommend that you practice making conversation in other situations as well (for example, at home, at parties, at the bus stop, in the elevator, and so on). 如果你在各种不同的情境和环境中练习暴露，你的收获更有可能持续更久。例如，如果你害怕开始对话，我们建议你不仅在工作场合练习开始对话，还应在其他场合练习（例如，在家里、聚会、公交车站、电梯里等等）。
Take Advantage of Opportunities to Overlearn 利用机会进行过度学习
Overlearning involves (1) practicing exposure so many times that it becomes boring and second nature, and (2) practicing exposure in situations more difficult than those you encounter in your everyday life. For example, if you are fearful of having your hands shake while having a drink, you can practice having them shake so much that you actually spill some of your drink. (Make sure your glass is filled with water and not grape juice!) Repeat this practice until it no longer causes anxiety. Or, if you’re fearful of making a minor mistake when talking to a stranger, you can practice purposely making obvious mistakes while speaking to people you don’t know. 过度学习包括（1）反复练习暴露，直到感到无聊且成为第二天性；（2）在比日常生活中遇到的情境更困难的情况下练习暴露。例如，如果你害怕喝饮料时手抖，你可以练习让手抖到实际上洒出一些饮料。（确保你的杯子里装的是水，而不是葡萄汁！）重复这种练习，直到不再引起焦虑。或者，如果你害怕与陌生人交谈时犯小错误，你可以练习故意在与不认识的人说话时犯明显的错误。
Overlearning is thought to offer protection from experiencing a return of fear. There are several advantages of practicing exposure to more difficult situations than those you normally encounter. First, practicing in more challenging situations will automatically make the less challenging situations seem easier. Second, practices in difficult situations will further challenge your anxious beliefs. For example, if you learn that nothing bad happens even if you purposely make a big mistake during a presentation, you may become less fearful of accidentally making a small mistake when speaking in public. Finally, overlearning provides room for some of your fear to return without causing significant impairment in your life. 过度学习被认为可以防止恐惧的复发。练习面对比你平时遇到的更困难的情境有几个好处。首先，在更具挑战性的情境中练习会自动让较不具挑战性的情境显得更容易。其次，在困难情境中的练习会进一步挑战你的焦虑信念。例如，如果你发现即使在演讲时故意犯一个大错误也不会发生什么坏事，你可能会减少对在公众场合讲话时不小心犯小错误的恐惧。最后，过度学习为你的部分恐惧回归留有余地，但不会对你的生活造成重大影响。
WHERE TO GO FOR MORE INFORMATION 更多信息来源
For those who want additional information on social anxiety and related topics, we have included more useful information at the back of this book. Our list of recommended readings includes books on social anxiety, other anxiety problems, cognitive behavioral therapy, and related topics. This list also includes information on two videos on the treatment of social anxiety. Readings are included both for consumers and professionals. We have also included a resource list of national and international organizations that provide information (including referrals to experienced therapists) to people who suffer from social anxiety and for professionals who have an interest in this topic. Finally, we have included a list of websites that provide information on social anxiety and effective treatments. 对于那些想了解更多关于社交焦虑及相关主题信息的人，我们在本书后面附加了更多有用的信息。我们的推荐阅读书目包括关于社交焦虑、其他焦虑问题、认知行为疗法及相关主题的书籍。该书目还包括两部关于社交焦虑治疗的视频信息。阅读材料既适合普通读者，也适合专业人士。我们还提供了一份国家和国际组织的资源清单，这些组织为社交焦虑患者及对此主题感兴趣的专业人士提供信息（包括推荐经验丰富的治疗师）。最后，我们列出了一些提供社交焦虑及有效治疗信息的网站。
We hope that you have found the strategies described in this book helpful. Chances are that you will need to continue to use these tools for some time before experiencing a reduction in social anxiety that has a noticeable impact on your day-to-day life. We recommend that you reread the sections that were particularly useful or inspiring to you. Most of all, we wish you good luck as you learn to deal with stressful social situations with a new, well-earned sense of confidence. 我们希望您觉得本书中描述的策略对您有所帮助。您很可能需要持续使用这些工具一段时间，才能体验到社交焦虑明显减轻，并对您的日常生活产生积极影响。我们建议您重新阅读那些对您特别有用或启发性的章节。最重要的是，我们祝愿您在学习以一种新获得的自信心应对压力社交场合时好运。
Recommended Readings 推荐阅读
SHYNESS AND SOCIAL ANXIETY: SELF-HELP BOOKS 害羞与社交焦虑：自助书籍
Antony, M.M. 2004. 10 Simple Solutions to Shyness: How to Overcome Shyness, Social Anxiety, and Fear of Public Speaking. Oakland, CA: New Harbinger. Antony, M.M. 2004. 《10 个简单解决害羞的方法：如何克服害羞、社交焦虑和公众演讲恐惧》。加利福尼亚州奥克兰：New Harbinger 出版社。
Hope, D.A., R.G. Heimberg, H.R. Juster, and C.L. Turk. 2000. Managing Social Anxiety. New York: Oxford. Hope, D.A., R.G. Heimberg, H.R. Juster, 和 C.L. Turk. 2000. 《管理社交焦虑》。纽约：牛津大学出版社。
Rapee, R.M. 1998. Overcoming Shyness and Social Phobia: A Step-by-Step Guide. Lanham, MD: Jason Aronson. Rapee, R.M. 1998. 《克服害羞与社交恐惧：一步步指南》。马里兰州兰哈姆：Jason Aronson 出版社。
Stein, M.B., and J.R. Walker. 2002. Triumph Over Shyness: Conduering Shyness and Social Anxiety. New York: McGraw-Hill. Stein, M.B., 和 J.R. Walker. 2002. 《战胜害羞：征服害羞与社交焦虑》。纽约：麦格劳-希尔出版社。
SOCIAL AND COMMUNICATION SKILLS: SELF-HELP BOOKS 社交与沟通技能：自助书籍
Dating and Meeting New People 约会与结识新朋友
Berry, D.M. 2005. Romancing the Web: A Therapist’s Guide to the Finer Points of Online Dating. Manitowoc, WI: Blue Water Publications. Berry, D.M. 2005. 《网络浪漫：治疗师的在线约会精要指南》。威斯康星州马尼托沃克：蓝水出版社。
Jacobson, B., and S.J. Gordon. 2004. The Shy Single: A Bold Guide to Dating for the Less-than-Bold Dater. Emmaus, PA: Rodale. Jacobson, B., 和 S.J. Gordon. 2004. 《害羞单身者：不那么大胆的约会者的勇敢约会指南》。宾夕法尼亚州埃玛斯：罗达尔出版社。
Katz, E.M. 2003. I Can’t Believe I’m Buying this Book: A Commonsense Guide to Successful Internet Dating. Berkeley, CA: 10 Speed Press. Katz, E.M. 2003。《我真不敢相信我买了这本书：成功网络约会的常识指南》。加利福尼亚州伯克利：10 Speed Press。
Tessina, T. 1998. The Unofficial Guide to Dating Again. New York: Macmillan. Tessina, T. 1998。《非官方的再约会指南》。纽约：麦克米兰。
Interviews 访谈
Fry, R. 2007. 101 Great Answers to the Toughest Interview Questions, 5th ed. Clifton Park, NY: Thomson Delmar Learning. Fry, R. 2007。《101 个最难面试问题的绝佳答案》，第 5 版。纽约克利夫顿帕克：汤姆森德尔玛学习出版社。
McKay, D.R. 2004. The Everything Practice Interview Book: Be Prepared for Any Question. Avon, MA: Adams Media Corporation. McKay, D.R. 2004。《全能面试实战手册：准备应对任何问题》。马萨诸塞州埃文：亚当斯传媒公司。
Stein, M. 2003. Fearless Interviewing: How to Win the Job by Communicating with Confidence. New York: McGraw-Hill. Stein, M. 2003。《无畏面试：如何通过自信沟通赢得工作》。纽约：麦格劳-希尔。
Public Speaking and Presentations 公众演讲与演示
Kosslyn, S.M. 2007. Clear and to the Point: 8 Psychological Principles for Compelling PowerPoint Presentations. New York: Oxford. Kosslyn, S.M. 2007。《简明扼要：8 条心理学原则助力精彩 PowerPoint 演示》。纽约：牛津大学出版社。
MacInnis, J.L. 2006. The Elements of Great Public Speaking: How To Be Calm, Confident, and Compelling. Berkeley, CA: 10 Speed Press. MacInnis, J.L. 2006. 《伟大公众演讲的要素：如何保持冷静、自信和有说服力》。加利福尼亚州伯克利：10 Speed Press。
McClain, G.R. 2007. Presentations: Proven Techniques for Creating Presentations that Get Results, 2nd ed. Avon, MA: Adams Media Corporation. McClain, G.R. 2007. 《演示文稿：创造有效演示的验证技巧》，第 2 版。马萨诸塞州埃文：Adams Media Corporation。
Monarth, H., and L. Kase. 2007. The Confident Speaker: Beat Your Nerves and Communicate at Your Best in Any Situation. New York: McGraw-Hill. Monarth, H., 和 L. Kase. 2007. 《自信的演讲者：克服紧张，在任何情况下发挥最佳沟通能力》。纽约：McGraw-Hill。
Morrisey, G.L., T.L. Sechrest, and W.B. Warman. 1997. Loud and Clear: How to Prepare and Deliver Effective Business and Technical Presentations, 4th ed. Reading, MA: Addison-Wesley. Morrisey, G.L., T.L. Sechrest, 和 W.B. Warman. 1997. 《响亮而清晰：如何准备和进行有效的商务及技术演示》，第 4 版。马萨诸塞州雷丁：Addison-Wesley。
Other Communication Skills 其他沟通技巧
Bolton, R. 1979. People Skills. New York: Simon & Schuster. Bolton, R. 1979。《人际交往技巧》。纽约：西蒙与舒斯特出版社。
Davis, M., K. Paleg, and P. Fanning. 2004. The Messages Workbook: Powerful Strategies for Effective Communication at Work & Home. Oakland, CA: New Harbinger. Davis, M., K. Paleg, 和 P. Fanning。2004。《信息工作手册：职场与家庭有效沟通的强大策略》。加利福尼亚州奥克兰：新先驱出版社。
Fleming, J. 1997. Become Assertive! Kent, United Kingdom: David Grant Publishing. Fleming, J. 1997。《变得自信！》英国肯特：大卫·格兰特出版社。
Garner, A. 1997. Conversationally Speaking: Testing New Ways to Increase Your Personal and Social Effectiveness, 3rd ed. Los Angeles: Lowell House. Garner, A. 1997. 《会话技巧：测试提升个人与社交效能的新方法》，第 3 版。洛杉矶：Lowell House。
Honeychurch, C., and A. Watrous. 2003. Talk to Me: Conversation Tips for the Small-Talk Challenged. Oakland, CA: New Harbinger. Honeychurch, C. 和 A. Watrous. 2003. 《跟我说话：为小谈话困难者提供的会话技巧》。加利福尼亚州奥克兰：New Harbinger。
McKay, M., M. Davis, and P. Fanning. 1995. Messages: The Communication Skills Book, 2nd ed. Oakland, CA: New Harbinger. McKay, M., M. Davis 和 P. Fanning. 1995. 《信息传递：沟通技巧书》，第 2 版。加利福尼亚州奥克兰：New Harbinger。
Patterson, R.J. 2000. The Assertiveness Workbook: How to Express Your Ideas and Stand Up for Yourself at Work and in Relationships. Oakland, CA: New Harbinger. Patterson, R.J. 2000. 《自信表达工作手册：如何在工作和人际关系中表达你的想法并为自己挺身而出》。加利福尼亚州奥克兰：New Harbinger。
ANXIETY DISORDERS AND COGNITIVE BEHAVIOR THERAPY: SELF-HELP BOOKS 焦虑症与认知行为疗法：自助书籍
Antony, M.M., and R.E. McCabe. 2004. 10 Simple Solutions to Panic: How to Overcome Panic Attacks, Calm Physical Symptoms, and Reclaim Your Life. Oakland, CA: New Harbinger. Antony, M.M.，和 R.E. McCabe。2004 年。《10 个简单解决惊恐的方法：如何克服惊恐发作，平息身体症状，重获新生》。加利福尼亚州奥克兰：New Harbinger 出版社。
Antony, M.M., and R.P. Swinson. 2008. When Perfect Isn’t Good Enough: Strategies for Coping with Perfectionism, 2nd ed. Oakland, CA: New Harbinger. Antony, M.M.，和 R.P. Swinson。2008 年。《当完美不够好：应对完美主义的策略，第 2 版》。加利福尼亚州奥克兰：New Harbinger 出版社。
Bieling, P.J., and M.M. Antony. 2003. Ending the Depression Cycle: A Step-by-Step Guide for Preventing Relapse. Oakland, CA: New Harbinger. Bieling, P.J.，和 M.M. Antony。2003 年。《结束抑郁循环：预防复发的逐步指南》。加利福尼亚州奥克兰：New Harbinger 出版社。
Bourne, E.J. 2005. The Anxiety and Phobia Workbook, 4th ed. Oakland, CA: New Harbinger. Bourne, E.J. 2005. 《焦虑与恐惧症工作手册》，第 4 版。加利福尼亚州奥克兰：New Harbinger 出版社。
——. 2003. Coping with Anxiety: 10 Simple Ways to Relieve Anxiety, Fear & Worry. Oakland, CA: New Harbinger. ——。2003。《应对焦虑：缓解焦虑、恐惧与担忧的 10 种简单方法》。加利福尼亚州奥克兰：New Harbinger 出版社。
Burns, D.D. 1999. The Feeling Good Handbook, Revised Edition. New York: Plume. Burns, D.D. 1999. 《感觉良好手册》，修订版。纽约：Plume 出版社。
Butler, G., and T. Hope. 2007. Manading Your Mind: The Mental Fitness Guide, 2nd ed. New York: Oxford. Butler, G. 和 T. Hope. 2007. 《管理你的心智：心理健康指南》，第 2 版。纽约：牛津大学出版社。
Davis, M., E.R. Eshelman, and M. McKay. 2008. The Relaxation and Stress Reduction Workbook, 6th ed. Oakland, CA: New Harbinger. Davis, M., E.R. Eshelman, 和 M. McKay. 2008. 《放松与减压工作手册》，第 6 版。加利福尼亚州奥克兰：New Harbinger 出版社。
Greenberger, D., and C.A. Padesky. 1995. Mind Over Mood: Change How You Feel by Changing the Way You Think. New York: Guilford. Greenberger, D., 和 C.A. Padesky. 1995. 《心态胜于情绪：通过改变思维方式改变你的感受》。纽约：Guilford 出版社。
Gyoerkoe, K.L., and P.S. Wiegartz. 2006. 10 Simple Solutions to Worry: How to Calm Your Mind, Relax Your Body, & Reclaim Your Life. Oakland, CA: New Harbinger. Gyoerkoe, K.L., 和 P.S. Wiegartz. 2006. 《解决担忧的 10 个简单方法：如何平静你的心灵，放松你的身体，重获生活》。加利福尼亚州奥克兰：New Harbinger 出版社。
Hyman, B.M., and C. Pedrick. 2005. The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder, 2nd ed. Oakland, CA: New Harbinger. Hyman, B.M., 和 C. Pedrick. 2005. 《强迫症工作手册：摆脱强迫症的指南》，第 2 版。加利福尼亚州奥克兰：New Harbinger 出版社。
McKay, M., M. Davis, and P. Fanning. 2007. Thoughts and Feelings: Taking Control of Your Moods and Your Life, 3rd ed. Oakland, CA: New Harbinger. McKay, M., M. Davis, 和 P. Fanning. 2007. 《思想与情感：掌控你的情绪和生活》，第 3 版。加利福尼亚州奥克兰：New Harbinger 出版社。
Zuercher-White, E. 1997. An End to Panic: Breakthrough Techniques for Overcoming Panic Disorder, 2nd ed. Oakland, CA: New Harbinger. Zuercher-White, E. 1997. 《终结恐慌：克服恐慌障碍的突破性技巧》，第 2 版。加利福尼亚州奥克兰：New Harbinger 出版社。
SOCIAL ANXIETY: BOOKS FOR PROFESSIONALS 社交焦虑：专业人士书籍推荐
Antony, M.M., and K. Rowa. 2008. Social Anxiety Disorder: Psychological Approaches to Assessment and Treatment. Göttingen, Germany: Hogrefe. Antony, M.M., 和 K. Rowa. 2008. 《社交焦虑障碍：评估与治疗的心理学方法》。德国哥廷根：Hogrefe 出版社。
Beidel, D.C., and S.M. Turner. 2007. Shy Children, Phobic Adults: Nature and Treatment of Social Anxiety Disorder, 2^("nd ")2{ }^{\text {nd }} ed. Washington, DC: American Psychological Association. Beidel, D.C.，和 S.M. Turner。2007。《害羞的儿童，恐惧的成年人：社交焦虑障碍的本质与治疗》，第 2^("nd ")2{ }^{\text {nd }} 版。华盛顿特区：美国心理学会。
Crozier, W.R., and L.E. Alden, eds. 2005. The Essential Handbook of Social Anxiety for Clinicians. Hoboken, NJ: Wiley. Crozier, W.R.，和 L.E. Alden，编。2005。《临床医生社交焦虑必备手册》。新泽西霍博肯：Wiley 出版社。
Heimberg, R.G., and R.E. Becker. 2002. Cognitive-Behavioral Group Therapy for Social Phobia: Basic Mechanisms and Clinical Strategies. New York: Guilford. Heimberg, R.G.，和 R.E. Becker。2002。《社交恐惧的认知行为团体治疗：基本机制与临床策略》。纽约：Guilford 出版社。
Hofmann, S.G. 2008. Cognitive-Behavior Therapy of Social Phobia: Evidence-Based and Disorder Specific Treatment Techniques. New York: Routledge. Hofmann, S.G. 2008。《社交恐惧的认知行为疗法：循证且针对性强的治疗技术》。纽约：Routledge 出版社。
Hofmann, S.G., and P.M. DiBartolo. 2001. From Social Anxiety to Social Phobia: Multiple Perspectives. Needham Heights, MA: Allyn and Bacon. Hofmann, S.G. 和 P.M. DiBartolo. 2001. 《从社交焦虑到社交恐惧症：多重视角》。马萨诸塞州尼达姆高地：Allyn and Bacon 出版社。
Hope, D.A., R.G. Heimberg, and C.L. Turk. 2006. Managing Social Anxiety: A Cognitive Behavioral Therapy Approach (Therapist Guide). New York: Oxford. Hope, D.A., R.G. Heimberg 和 C.L. Turk. 2006. 《管理社交焦虑：认知行为疗法方法（治疗师指南）》。纽约：牛津大学出版社。
Kearney, C.A. 2005. Social Anxiety and Social Phobia in Youth: Characteristics, Assessment, and Psychological Treatment. New York: Springer. Kearney, C.A. 2005. 《青少年的社交焦虑与社交恐惧症：特征、评估与心理治疗》。纽约：Springer 出版社。
Stravynski, A. 2007. Fearing Others: The Nature and Treatment of Social Phobia. New York: Cambridge. Stravynski, A. 2007. 《害怕他人：社交恐惧症的本质与治疗》。纽约：剑桥大学出版社。
ANXIETY DISORDERS AND COGNITIVE BEHAVIOR THERAPY: BOOKS FOR PROFESSIONALS 焦虑障碍与认知行为疗法：专业人士书籍推荐
Andrews, G., R. Crino, M. Creamer, C. Hunt, L. Lampe, and A. Page. 2002. The Treatment of Anxiety Disorders: Clinician’s Guide and Patient Manuals, 2nd ed. New York: Cambridge. Andrews, G., R. Crino, M. Creamer, C. Hunt, L. Lampe, 和 A. Page. 2002. 《焦虑障碍的治疗：临床医生指南与患者手册》，第 2 版。纽约：剑桥大学出版社。
Antony, M.M., and D.H. Barlow, eds. 2002. Handbook of Assessment, Treatment Planning, and Outcome Evaluation: Empirically Supported Strategies for Psychological Disorders. New York: Guilford. Antony, M.M., 和 D.H. Barlow（编）。2002. 《评估、治疗计划与结果评估手册：心理障碍的实证支持策略》。纽约：吉尔福德出版社。
Antony, M.M., and M.B. Stein. 2008. Oxford Handbook of Anxiety and Related Disorders. New York: Oxford University Press. Antony, M.M., 和 M.B. Stein. 2008. 《牛津焦虑及相关障碍手册》。纽约：牛津大学出版社。
Antony, M.M., and R.P. Swinson. 2000. Phobic Disorders and Panic in Adults: A Guide to Assessment and Treatment. Washington, DC: American Psychological Association. Antony, M.M. 和 R.P. Swinson. 2000. 《成人恐惧症和惊恐障碍：评估与治疗指南》。华盛顿特区：美国心理学会。
Antony, M.M., D.R. Ledley, and R.G. Heimberg, eds. 2005. Improving Outcomes and Preventing Relapse in Cognitive Behavioral Therapy. New York: Guilford. Antony, M.M., D.R. Ledley 和 R.G. Heimberg（编）。2005. 《认知行为疗法中的效果提升与复发预防》。纽约：吉尔福德出版社。
Antony, M.M., S.M. Orsillo, and L. Roemer, eds. 2001. Practitioner’s Guide to Empirically-Based Measures of Anxiety. New York: Springer. Antony, M.M., S.M. Orsillo 和 L. Roemer（编）。2001. 《基于实证的焦虑测量实务指南》。纽约：斯普林格出版社。
Barlow, D.H. 2002. Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic, 2nd ed. New York: Guilford. Barlow, D.H. 2002. 《焦虑及其障碍：焦虑与惊恐的本质及治疗》，第二版。纽约：吉尔福德出版社。
——. ed. 2008. Clinical Handbook of Psychological Disorders, 4th ed. New York: Guilford. ——. 编. 2008. 《心理障碍临床手册》，第 4 版。纽约：Guilford 出版社。
Beck, A.T., and G. Emery. 1985. Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books. Beck, A.T. 和 G. Emery. 1985. 《焦虑障碍与恐惧症：认知视角》。纽约：Basic Books 出版社。
Beck, J.S. 1995. Cognitive Therapy: Basics and Beyond. New York: Guilford. Beck, J.S. 1995. 《认知疗法：基础与进阶》。纽约：Guilford 出版社。
-. 2005. Cognitive Therapy for Challenging Problems: What To Do When the Basics Don’t Work. New York: Guilford. ——. 2005. 《应对挑战性问题的认知疗法：基础方法无效时该怎么办》。纽约：Guilford 出版社。
Bernstein, D.A., T.D. Borkovec, and H. Hazlett-Stevens. 2000. New Directions in Progressive Relaxation Training: A Guidebook for Helping Professionals. Westport, CT: Praeger. Bernstein, D.A., T.D. Borkovec, 和 H. Hazlett-Stevens. 2000. 渐进性放松训练的新方向：帮助专业人员的指南。康涅狄格州韦斯特波特：Praeger 出版社。
Bieling, P.J., R.E. McCabe, and M.M. Antony. 2006. Cognitive Bebavioral Therapy in Groups. New York: Guilford. Bieling, P.J., R.E. McCabe, 和 M.M. Antony. 2006. 团体认知行为疗法。纽约：Guilford 出版社。
Eifert, G.H., and J.P. Forsyth. 2005. Acceptance and Commitment Therapy for Anxiety Disorders: A Practitioner’s Treatment Guide to Using Mindfulness, Acceptance, and Values-Based Behavior Change Strategies. Oakland, CA: New Harbinger. Eifert, G.H., 和 J.P. Forsyth. 2005. 焦虑障碍的接纳与承诺疗法：使用正念、接纳和基于价值的行为改变策略的实践者治疗指南。加利福尼亚州奥克兰：New Harbinger 出版社。
Kase, L., and D. Ledley. 2007. Anxiety Disorders. Hoboken, NJ: Wiley. Kase, L., 和 D. Ledley. 2007. 焦虑障碍。新泽西州霍博肯：Wiley 出版社。
Miller, W.R., and S. Rollnick. 2002. Motivational Interviewing: Preparing People for Change, 2nd ed. New York: Guilford. Miller, W.R. 和 S. Rollnick. 2002. 《动机访谈：为改变做准备》，第 2 版。纽约：Guilford 出版社。
Orsillo, S.M., and L. Roemer, eds. 2005. Acceptance- and Mindfulness-Based Approaches to Anxiety: Conceptualization and Treatment. New York: Springer. Orsillo, S.M. 和 L. Roemer，编辑。2005. 《基于接纳与正念的焦虑治疗方法：概念化与治疗》。纽约：Springer 出版社。
Richard, D.C.S., and D. Lauterbach. 2007. Handbook of Exposure Therapies. New York: Academic Press. Richard, D.C.S. 和 D. Lauterbach. 2007. 《暴露疗法手册》。纽约：Academic Press 出版社。
Wright, J.H., M.R. Basco, and M.E. Thase. 2006. Learning Cognitive-Bebavior Therapy: An Illustrated Guide. Washington, DC: American Psychiatric Press. Wright, J.H., M.R. Basco 和 M.E. Thase. 2006. 《学习认知行为疗法：图解指南》。华盛顿特区：American Psychiatric Press 出版社。
VIDEO RESOURCES 视频资源
Albano, A.M. 2006. Shyness and Social Phobia. DVD. Washington, DC: American Psychological Association. Albano, A.M. 2006 年。《害羞与社交恐惧》。DVD。华盛顿特区：美国心理学会。
Rapee, R.M. 1999. I Think They Think … Overcoming Social Phobia. DVD or VHS. New York: Guilford. Rapee, R.M. 1999 年。《我觉得他们在想……克服社交恐惧》。DVD 或 VHS。纽约：Guilford 出版社。
National and International Associations Providing Referrals 提供转介服务的国内外协会
NATIONAL ASSOCIATIONS (UNITED STATES) 美国全国协会
Note that most of these associations offer information for finding therapists and other resources in the United States and Canada, and several offer information on resources in other countries. 请注意，这些协会大多数提供在美国和加拿大寻找治疗师及其他资源的信息，且有几家提供其他国家资源的信息。
Anxiety Disorders Association of America 美国焦虑症协会
8730 Georgia Ave., Suite 600 乔治亚大道 8730 号，600 室
Silver Spring, MD 20910 马里兰州银泉 20910
USA 美国
Tel: 1-240-485-1001 电话：1-240-485-1001
Fax: 1-240-485-1035 传真：1-240-485-1035
Web: www.adaa.org 网站：www.adaa.org
Annual conference (for professionals and consumers) 年度会议（面向专业人士和消费者）
Consumer memberships and professional memberships 消费者会员和专业会员
Information on support groups in the United States, Canada, South Africa, Mexico, and Australia 关于美国、加拿大、南非、墨西哥和澳大利亚支持小组的信息
The Shyness & Social Anxiety Workbook 害羞与社交焦虑工作手册
Names of professionals who treat anxiety disorders in the United States, Canada, and elsewhere 在美国、加拿大及其他地区治疗焦虑症的专业人士名单
Association for Behavioral and Cognitive Therapies 行为与认知疗法协会
305 Seventh Ave., 16th Floor 第七大道 305 号，16 楼
New York, NY 10001-6008 纽约，纽约州 10001-6008
USA 美国
Tel: 1-212-647-1890 电话：1-212-647-1890
Fax: 1-212-647-1865 传真：1-212-647-1865
Web: www.abct.org 网站：www.abct.org
Professional memberships only, but offers referrals to consumers 仅限专业会员，但向消费者提供推荐
One Belmont Ave., Suite 700
Bala Cynwyd, PA 19004-1610
USA 美国
Tel: 1-610-664-1273 电话：1-610-664-1273
Fax: 1-610-664-5137 传真：1-610-664-5137
E-mail: info@academyofct.org 电子邮件：info@academyofct.org
Web: www.academyofct.org 网站：www.academyofct.org
Professional memberships only, but offers referrals for consumers to certified cognitive therapists 仅限专业会员，但为消费者提供认证认知治疗师的推荐服务
American Academy of Cognitive and Behavioral Psychology 美国认知与行为心理学会
Attn: E. Thomas Dowd, Ph.D., ABPP 收件人：E. Thomas Dowd 博士，ABPP
Department of Psychology 心理学系
Kent State University 肯特州立大学
Kent, OH 44242 俄亥俄州肯特市 44242
USA 美国
Tel: 1-330-672-7664 电话：1-330-672-7664
Fax: 1-330-672-3786 传真：1-330-672-3786
E-mail: edowd@kent.edu 电子邮件：edowd@kent.edu
Web: www.americanacademyofbehavioralpsychology.org 网站：www.americanacademyofbehavioralpsychology.org
Professional memberships only, but offers referrals for consumers to boardcertified psychologists in cognitive behavioral psychology www.american academyofbehavioralpsychology.org/AABP/FellowDirectory.htm 仅限专业会员，但为消费者提供认知行为心理学领域持证心理学家的推荐 www.americanacademyofbehavioralpsychology.org/AABP/FellowDirectory.htm
Freedom From Fear
308 Seaview Ave.
Staten Island, NY 10305
USA
Tel: 1-718-351-1717, ext. 24
Web: www.freedomfromfear.org
E-mail: help@freedomfromfear.org Freedom From Fear
308 Seaview Ave. Staten Island, NY 10305 美国
电话：1-718-351-1717，分机 24
网站：www.freedomfromfear.org
电子邮件：help@freedomfromfear.org
National nonprofit advocacy organization for people with anxiety disorders and depression 美国国家非营利性焦虑症和抑郁症患者权益倡导组织
Newsletter, blogs, bookstore 通讯、博客、书店
Information on support groups and other resources 关于支持小组和其他资源的信息
American Psychological Association 美国心理学会
750 First St., N.E.
Washington, DC 20002-4242 华盛顿，DC 20002-4242
USA 美国
Tel: 1-800-374-2721 电话：1-800-374-2721
Web: www.apa.org 网站：www.apa.org
Professional memberships only, but offers referrals to consumers 仅限专业会员，但向消费者提供推荐服务
APA Answer Center APA 答疑中心
1000 Wilson Blvd., Suite 1825
Arlington, VA 22209 弗吉尼亚州阿灵顿 22209
USA 美国
Tel: 1-888-35-PSYCH or 1-703-907-7300 电话：1-888-35-PSYCH 或 1-703-907-7300
E-mail: apa@psych.org 电子邮件：apa@psych.org
Web: www.psych.org 网站：www.psych.org
Professional memberships only, but offers referrals to consumers 仅限专业会员，但向消费者提供推荐
Professional memberships only, but offers referrals for consumers to cognitive therapists: http://www.cognitivetherapyassociation.org/refhome.aspx 仅限专业会员，但为消费者提供认知治疗师推荐：http://www.cognitivetherapyassociation.org/refhome.aspx
British Association for Behavioural and Cognitive Psychotherapies 英国行为与认知心理治疗协会
Victoria Buildings 维多利亚大厦
9-13 Silver Street 银街 9-13 号
Bury BL9 0EU 伯里 BL9 0EU
United Kingdom 英国
Tel: 01617974484 电话：01617974484
Fax: 01617972670 传真：01617972670
E-mail: babcp@babcp.com 电子邮件：babcp@babcp.com
Web: www.babcp.com 网站：www.babcp.com
Professional memberships only, but website includes a “find a therapist” feature for consumers. 仅限专业会员，但网站包含面向消费者的“寻找治疗师”功能。
Australian Association for Cognitive and Behaviour Therapy 澳大利亚认知与行为治疗协会
Professional memberships only, but website includes a list of CBT practitioners for consumers (click on the “state branches” link at the top, and then click the link near the bottom of the list). 仅限专业会员，但网站包含面向消费者的认知行为疗法从业者名单（点击顶部的“州分支”链接，然后点击列表底部附近的链接）。
Internet Resources 互联网资源
Although the information in this section was up to date when this book went to press, Web pages come and go, and addresses for Internet resources change frequently. For additional information on Internet resources, we suggest doing a search using keywords such as social phobia, social anxiety, and shyness. Note that although we have screened each of these sites, we have not reviewed them in detail and cannot take responsibility for the accuracy of the information they contain. 虽然本节中的信息在本书出版时是最新的，但网页经常变动，互联网资源的网址也经常更改。有关互联网资源的更多信息，我们建议使用社交恐惧、社交焦虑和害羞等关键词进行搜索。请注意，虽然我们已筛选过这些网站，但未对其内容进行详细审查，因此无法对其信息的准确性负责。
A very informative anxiety self-help site run by the Anxiety Disorders Treatment Center (and Dr. R. Reid Wilson) in Durham, NC 这是一个非常有用的焦虑自助网站，由北卡罗来纳州达勒姆的焦虑障碍治疗中心（以及 R. Reid Wilson 博士）运营
A place for online forums and chats about social phobia 一个关于社交恐惧的在线论坛和聊天平台
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Martin M. Antony, Ph.D., is professor of psychology at Ryerson University in Toronto, ON, and director of research at the Anxiety Treatment and Research Centre at St. Joseph’s Healthcare in Hamilton, ON. He is also president-elect of the Canadian Psychological Association. He has published twenty-four books and more than 100 scientific papers and book chapters in the areas of cognitive behavior therapy and anxiety disorders. He has received early career awards from the Society of Clinical Psychology (American Psychological Association), the Canadian Psychological Association, and the Anxiety Disorders Association of America, and is a fellow of the American and Canadian Psychological Associations. He is past president of the Anxiety Disorders Special Interest Group of the Association for Behavioral and Cognitive Therapies (ABCT) and has been program chair for the ABCT annual convention. He is actively involved in clinical research in the area of anxiety disorders, teaching, and education, and maintains a clinical practice. Visit him online at www.martinantony.com. Martin M. Antony 博士是加拿大安大略省多伦多赖尔森大学的心理学教授，同时担任安大略省汉密尔顿圣约瑟夫医疗中心焦虑治疗与研究中心的研究主任。他还是加拿大心理学会的当选主席。他在认知行为疗法和焦虑障碍领域发表了二十四本书籍以及一百多篇科学论文和书籍章节。他曾获得美国心理学会临床心理学分会、加拿大心理学会以及美国焦虑障碍协会的早期职业奖项，并且是美国和加拿大心理学会的会士。他曾任行为与认知疗法协会（ABCT）焦虑障碍特别兴趣小组主席，并担任过 ABCT 年会的项目主席。他积极参与焦虑障碍领域的临床研究、教学和教育工作，并保持临床实践。可访问他的网站：www.martinantony.com。
Richard P. Swinson, MD, is professor emeritus and past chair of the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton, ON, Canada. He is also medical director of the Anxiety Treatment and Research Centre and past psychiatrist-in-chief at Joseph’s Healthcare, also in Hamilton. He is a fellow of the Royal College of Physicians and Surgeons of Canada, the American Psychiatric Association, and the Royal College of Psychiatrists UK. He was awarded an inaugural fellowship of the Canadian Psychiatric Association in 2006. His research interests lie in the theory, assessment and treatment of anxiety disorders, particularly obsessivecompulsive disorder and social anxiety disorder. He has published more than 180 peerreviewed papers, thirty book chapters, and eight books. Dr. Swinson has held numerous research grants since 1966 and has been an invited speaker at many conferences around the world on anxiety disorders and substance use disorders. He also chaired the steering committee for the Canadian Anxiety Treatment Guidelines Initiative, leading to the publication of Canadian Clinical Practice Guidelines for the Management of Anxiety Disorders in 2006. 理查德·P·斯温森医学博士是加拿大安大略省汉密尔顿麦克马斯特大学精神病学与行为神经科学系的名誉教授及前系主任。他还是焦虑治疗与研究中心的医疗主任，以及同在汉密尔顿的约瑟夫医疗中心的前首席精神科医生。他是加拿大皇家内科医师与外科医师学院、美国精神病学会和英国皇家精神病学会的院士。2006 年，他获得了加拿大精神病学会的首届院士荣誉。他的研究兴趣集中在焦虑障碍的理论、评估和治疗，特别是强迫症和社交焦虑障碍。他发表了 180 多篇同行评审论文、30 章书籍章节和 8 本专著。自 1966 年以来，斯温森博士获得了众多研究资助，并曾作为受邀演讲嘉宾在全球多场关于焦虑障碍和物质使用障碍的会议上发言。他还曾担任加拿大焦虑治疗指南倡议的指导委员会主席，推动了 2006 年《加拿大焦虑障碍管理临床实践指南》的发布。
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Martin M. Antony, Karen Rowa Martin M. Antony，Karen Rowa
Social Anxiety Disorder 社交焦虑障碍
In the series: Advances in Psychotherapy - Evidence-Based Practice 系列丛书：心理治疗进展——循证实践
2008, X + 102 pages, softcover, US 24.95 (Series Standing Order: US $19.95\$ 19.95 ) ISBN: 978-0-88937-311-2 2008 年，X + 102 页，平装，售价 24.95 美元（系列订购价：美国 $19.95\$ 19.95 ）ISBN：978-0-88937-311-2
Recent studies suggest that approximately 7% of Americans suffer from social anxiety disorder. In addition to the high percentage of people with symptoms meeting criteria for this disorder, many other individuals experience social anxiety or shyness to a lesser, but still impairing degree. Practitioners are likely to encounter patients displaying some degree of social anxiety, no matter what specialty service or setting they occupy. Over the past 20 years, effective tools have been developed to identify and treat social anxiety. This book provides straightforward, accessible assessment and treatment information for clinicians and students on the diagnosis, identification, conceptualization, and treatment of social anxiety and social phobia. 最新研究表明，大约 7%的美国人患有社交焦虑症。除了符合该障碍诊断标准的高比例患者外，许多其他人也经历不同程度的社交焦虑或害羞，虽然程度较轻，但仍然造成功能障碍。无论从事何种专业服务或工作环境，临床医生都可能遇到表现出某种程度社交焦虑的患者。在过去 20 年中，已经开发出有效的工具来识别和治疗社交焦虑。本书为临床医生和学生提供了关于社交焦虑和社交恐惧的诊断、识别、概念化及治疗的简明易懂的评估和治疗信息。
“This bookfills an important gap in the literature - filled with clinical examples and advice, its straightforward presentation will allow clinicians with various levels of expertise to implement these efficacious interventions. [The authors] provide not only a valuable tool for their colleagues, but also hope for the millions who suffer from SAD.” “这本书填补了文献中的一个重要空白——充满了临床案例和建议，其直截了当的呈现方式将使不同专业水平的临床医生能够实施这些有效的干预措施。[作者们]不仅为同行提供了宝贵的工具，也为数百万患有社交焦虑障碍的人带来了希望。”
Deborah C. Beidel, PhD, Professor and Director of Clinical Training, University of Central Florida, Orlando, FL Deborah C. Beidel，博士，佛罗里达中部大学临床培训教授兼主任，奥兰多，佛罗里达州
“[The authors] are to be congratulated for putting together a concise, practical, eminently readable primer on diagnosis and treatment of SAD. Yes, the advice is evidence-based, but it is also grounded in years of experience treating patients… It is required reading for any therapist seeking to broaden or sharpen their expertise in this area.” “[作者们]值得称赞，他们汇编了一本简明、实用且极易阅读的社交焦虑障碍诊断与治疗入门书。是的，书中的建议是基于证据的，但同样根植于多年治疗患者的经验……这本书是任何希望拓宽或提升该领域专业知识的治疗师必读之作。”
Murray B. Stein, MD, MPH, Professor, Department of Psychiatry, and Director, Anxiety & Traumatic Stress Disorders Program, University of California San Diego, CA Murray B. Stein，医学博士，公共卫生硕士，加州大学圣地亚哥分校精神病学系教授兼焦虑与创伤应激障碍项目主任，加利福尼亚州
Table of Contents 目录
1 Description: Terminology • Definition • Epidemiology • Course and Prognosis • Differential Diagnosis • Comorbidity • Diagnostic Procedures and Documentation 1 描述：术语 • 定义 • 流行病学 • 过程与预后 • 鉴别诊断 • 共病 • 诊断程序与记录
2 Psychological Approaches to Understanding Social Anxiety Disorder: The Cognitive Model of Clark and Wells • The Cognitive Behavioral Model of Rapee and Heimberg • Negative Learning Experiences and Social Anxiety • Temperamental Bases of SAD • Implications for Treatment 2 理解社交焦虑障碍的心理学方法：Clark 和 Wells 的认知模型 • Rapee 和 Heimberg 的认知行为模型 • 负面学习经历与社交焦虑 • 社交焦虑障碍的气质基础 • 治疗启示
3 Diagnosis and Treatment Indications: Key Features to be Assessed • Overview of Effective Treatment Strategies • Factors That Influence Treatment Decisions 3 诊断与治疗指征：需评估的关键特征 • 有效治疗策略概述 • 影响治疗决策的因素
4 Treatment: Methods of CBT • Mechanisms of Action • Efficacy - Combination Treatments • Overcoming Barriers to Treatment • Adapting Treatment for Different Age Groups • Adapting Treatment for Different Cultures 4 治疗：认知行为疗法方法 • 作用机制 • 疗效 - 组合治疗 • 克服治疗障碍 • 针对不同年龄组调整治疗 • 针对不同文化调整治疗
5 Case Vignettes • 6 Further Reading • 7 References • 8 Appendix: Tools and Resources 5 案例小插曲 • 6 进一步阅读 • 7 参考文献 • 8 附录：工具和资源
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Is Fear of Social Situations Keeping You from Living the Life You Want? 害怕社交场合是否阻碍了你过上理想生活？
T’here’s nothing wrong with being shy. But if social anxiety keeps you from forming relationships with others, advancing in your education or your career, or carrying on with everyday activities, you may need to confront your fears to live an enjoyable, satisfying life. This new edition of The Shyness and Social Anxiety Workbook offers a comprehensive program to help you do just that. 害羞本身没有错。但如果社交焦虑让你无法与他人建立关系，无法在学业或职业上取得进步，或无法正常进行日常活动，你可能需要面对自己的恐惧，才能过上愉快且满足的生活。本新版《害羞与社交焦虑工作手册》提供了一个全面的方案，帮助你实现这一目标。
As you complete the activities in this workbook, you’ll learn to: 在完成本手册中的活动时，你将学会：
Find your strengths and weaknesses with a self-evaluation - Explore and examine your fears 通过自我评估发现你的优点和缺点——探索并审视你的恐惧
Create a personalized plan for change 制定个性化的改变计划
Put your plan into action through gentle and gradual exposure to social situations 通过温和且逐步地接触社交场合，将你的计划付诸行动
Information about therapy, medications, and other resources is also included. After completing this program, you’ll be well-equipped to make connections with the people around you. Soon, you’ll be on your way to enjoying all the benefits of being actively involved in the social world. 书中还包含有关治疗、药物和其他资源的信息。完成本课程后，你将具备与周围人建立联系的能力。不久，你将开始享受积极参与社交世界的所有好处。
“Anyone who experiences significant anxiety when performing or when interacting with other people should read this book!” - AARON T. BECK, MD, university professor of psychiatry at the University of Pennsylvania “任何在表演或与他人交往时感到显著焦虑的人都应该阅读这本书！”——亚伦·T·贝克医学博士，宾夕法尼亚大学精神病学教授
“Based on the tried and true methods of cognitive-behavioral therapy… the techniques described in this book will help you feel better when you are with other people or the center of attention.” “基于经过验证的认知行为疗法方法……本书中描述的技巧将帮助你在与他人相处或成为关注焦点时感觉更好。”
-RICHARD HEIMBERG, PH.D., director of the Adult Anxiety Clinic of Temple University, Philadelphia ——理查德·海姆伯格博士，费城天普大学成人焦虑诊所主任
“This volume, written by a team composed of a psychologist and a psychiatrist, is an outstanding workbook for any individual suffering from social anxiety or shyness.” -JACQUELINE B. PERSONS, PH.D., clinical professor in the department of psychology at the University of California, Berkeley “这本书由一位心理学家和一位精神科医生组成的团队撰写，是任何遭受社交焦虑或害羞困扰的个体的杰出工作手册。”——杰奎琳·B·珀森斯博士，加州大学伯克利分校心理学系临床教授
“This is a must-read for persons suffering with social anxiety.” -MICHELLE G. CRASKE, PH.D., professor of psychology at the University of California, Los Angeles “这是社交焦虑患者必读的书。”——加州大学洛杉矶分校心理学教授 MICHELLE G. CRASKE 博士
MARTIN M. ANTONY, PH.D., is professor of psychology at Ryerson University in Toronto, director of research at the Anxiety Treatment and Research Centre at St. Joseph’s Healthcare in Hamilton, ON, and president-elect of the Canadian Psychological Association. He lives in Toronto, ON, Canada. MARTIN M. ANTONY 博士是多伦多瑞尔森大学的心理学教授，安大略省汉密尔顿圣约瑟夫医疗中心焦虑治疗与研究中心的研究主任，加拿大心理学会当选主席。他现居加拿大安大略省多伦多市。
RICHARD P. SWINSON, MD, is professor emeritus and past chair of the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton, ON, Canada. He is also medical director of the Anxiety Treatment and Research Centre at Joseph’s Healthcare, also in Hamilton. Swinson lives in Toronto, ON, Canada. RICHARD P. SWINSON 医学博士是加拿大安大略省汉密尔顿麦克马斯特大学精神病学与行为神经科学系的名誉教授及前系主任，同时也是汉密尔顿圣约瑟夫医疗中心焦虑治疗与研究中心的医疗主任。Swinson 现居加拿大安大略省多伦多市。
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