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Social anxiety~20 min

Relapse prevention plan: social anxiety

A plan for keeping up your progress with social anxiety after therapy: what you learnt about how you come across, your early warning signs, how to keep practising, and what to do after a setback. Based on Clark and Wells (1995) and the relapse prevention approach of Larimer, Palmer and Marlatt (1999): it adds social anxiety warning signs and self-practice.

Written by Tarun Vermani, Trainee Clinical Psychologist Updated

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Fill this in towards the end of therapy, with your therapist. It brings together what you have learnt about social anxiety, the signs that old habits might be creeping back, how you will keep practising on your own, and what to do if you have a wobble. Feeling nervous before a big social event is normal and does not mean the problem is back. What matters is whether the old habits return: turning your attention inwards, hiding behind safety behaviours, and going over things afterwards. Keep this plan somewhere you can find it and read it again if you notice them. Therapist note: The social anxiety variant of the relapse prevention plan, with the same section and field ids as the general plan where a section carries over, and the same layout as the other presentation-specific relapse plans. Build it over the last two or three sessions from the client's formulation: the feared judgement, the self-image, the safety behaviours dropped and what experiments and video feedback showed. The keeping-it-going section is the client's own continued external focus, experiments and handling of post-event replay.

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What I've learned in therapy

Write down your own understanding of social anxiety, in your own words. This is the part you will most want to remember if the old fears come back.

Situations to watch out for

Some times make the old fears more likely to come back: a new job or course, meeting new people, being the centre of attention, an event that did not go the way you hoped, or a stressful patch in general. Planning for them helps.

My early warning signs

Feeling some nerves is not a warning sign on its own. The signs to watch for are the old habits coming back. Tick the ones that fit you.

If you drink heavily most days, or take benzodiazepines (such as diazepam) or opioids, stopping suddenly can be dangerous. Talk to your GP or therapist before you cut down or stop.

Warning signs that apply to me (tick any)

My coping toolkit

List the ideas and skills that helped you most. Choose ones that help you take part and find out what really happens, rather than ones that help you hide. For each, rate how well it works for you: 0 is not at all, 10 is very well.

#Strategy or techniqueWhen to use itWorks for me (0 to 10)Actions
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2
3

Keeping it going

What helped you in therapy will keep helping if you keep doing it. That usually means putting your attention on the people and the conversation rather than on yourself; leaving your safety behaviours behind; carrying on with small experiments to find out what really happens; and letting your picture of how you come across be tested against what you see. When you catch yourself going over an event afterwards, treat it as a cue to stop and turn to something else.

Choose which safety behaviours to drop with your therapist. Keep precautions that protect your real health or safety. Do not stop or change any prescribed medication on your own; talk to your prescriber first.

Things I will keep practising (tick any)
#What I will practiseSafety behaviour to dropHow oftenActions
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My action plan for setbacks

A setback is not a relapse. An awkward moment, or a time when the old fears come back, is common, especially when life is stressful or things are new. It does not mean you are back to square one: you still have the skills, and you can use them again.

Steps I will take after a setback

My support network

People who can help you keep going. Ask them to encourage you to join in and try things, not to speak for you or reassure you about how you came across.

#NameRelationshipHow they can helpContact detailsActions
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My commitment

Finish with a short promise to yourself about how you will keep going, and when you will look at this plan again.

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When to use ‘Relapse prevention plan: social anxiety’

‘Relapse prevention plan: social anxiety’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for social anxiety.

It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.

How it works

Most people work through it in around 20 minutes. It moves through six short steps:

  1. What I've learned in therapy: Write down your own understanding of social anxiety, in your own words. This is the part you will most want to remember if the old fears…
  2. Situations to watch out for: Some times make the old fears more likely to come back: a new job or course, meeting new people, being the centre of attention, an event…
  3. My early warning signs: Feeling some nerves is not a warning sign on its own. The signs to watch for are the old habits coming back. Tick the ones that fit…
  4. My coping toolkit: List the ideas and skills that helped you most. Choose ones that help you take part and find out what really happens, rather than ones that…
  5. Keeping it going: What helped you in therapy will keep helping if you keep doing it. That usually means putting your attention on the people and the…
  6. My action plan for setbacks: A setback is not a relapse. An awkward moment, or a time when the old fears come back, is common, especially when life is stressful or…

Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.

The CBT approach behind it

In common with other CBT methods, ‘Relapse prevention plan: social anxiety’ works by putting clear, personalised coping steps in place for difficult moments. The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.

Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.

Evidence & sources

This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:

  • Clark, D.M., & Wells, A. (1995). A cognitive model of social phobia. In R.G. Heimberg, M.R. Liebowitz, D.A. Hope, & F.R. Schneier (Eds.), Social Phobia: Diagnosis, Assessment, and Treatment (pp. 69-93). New York: Guilford Press.
  • Clark, D.M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., Waddington, L., & Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 568-578. doi:10.1037/0022-006X.74.3.568
  • Leigh, E., & Clark, D.M. (2018). Understanding social anxiety disorder in adolescents and improving treatment outcomes: Applying the cognitive model of Clark and Wells (1995). Clinical Child and Family Psychology Review, 21(3), 388-414. doi:10.1007/s10567-018-0258-5
  • Larimer, M.E., Palmer, R.S., & Marlatt, G.A. (1999). Relapse prevention: An overview of Marlatt's cognitive-behavioral model. Alcohol Research & Health, 23(2), 151-160.
  • National Institute for Health and Care Excellence (2013). Social anxiety disorder: recognition, assessment and treatment (CG159). London: NICE.

For use alongside professional support

Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.

If you need urgent help now:

  • Emergency services: 999 — if you or someone else is in immediate danger
  • NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
  • Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
  • Samaritans: 116 123 — free, day or night, 365 days a year
  • Shout: 85258 — text SHOUT, free, day or night
  • SANEline: 0300 304 7000 — 4pm–10pm, every day

More Social anxiety worksheets

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Compare the picture of yourself you get from how you feel with how you actually appear on video, and check how accurate it is. Do this with your therapist. Simplified from Warnock-Parkes et al. (2017), after Clark and Wells (1995): calibrating the recording, freeze-frames and feedback from others are left out.

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Self-image identification worksheet

Describe the negative picture of yourself that helps keep social anxiety going: how you imagine you look and sound to others, based on how you feel inside. Based on Clark and Wells (1995): the self-image step on its own, with questions on early memories and on testing the image added.

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Post-event processing record

Catch the replaying that follows social situations, notice what it costs you, and practise dropping it. Going over events afterwards is one of the things that keeps social anxiety going. Based on Clark and Wells (1995) and Wells (1997): it adds before and after ratings, a brief balanced view and a record of time spent and its cost.

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Attention refocusing experiment record

Compare focusing on yourself with focusing outward in similar social situations, to test your prediction about how anxious you feel and how you come across. Based on Clark and Wells (1995): a prediction, safety behaviours and belief ratings are added to the attention comparison.

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