Social anxiety significantly impacts workplace performance and interpersonal relationships, particularly affecting professional women in managerial positions. This case study presents a 61-year-old female manager from Boonooroo Plains, Queensland, who experienced severe social anxiety characterised by an External Locus of Control and Global Attribution patterns. Clinical assessment revealed elevated baseline scores: DASS-21 Anxiety (14), DASS-21 Stress (10), DAS (129), and SUDS (8). The intervention utilised Skill Building and Reframing hypnotic devices across 2 sessions to transfer agency back to the client and restructure cognitive distortions. Post-treatment outcomes demonstrated substantial improvements: DASS-21 Anxiety reduced to 4 (71% improvement), DASS-21 Stress to 4 (60% improvement), DAS to 54 (58% improvement), and SUDS to 0 (100% improvement). These results support the efficacy of targeted hypnotherapeutic interventions for social anxiety through psychological pattern modification.
The Challenge
The primary therapeutic challenge involved shifting deeply entrenched beliefs about personal agency and control. The client's External Locus of Control pattern meant she attributed all anxiety responses to external factors: 'other people's behaviour,' 'unexpected situations,' or 'workplace pressure.' This attribution style prevented her from recognising her own capacity for influence and change. Simultaneously, her Global Attribution pattern led to overgeneralisation, where anxiety in one social context contaminated her confidence across all interpersonal situations. The combination created a self-perpetuating cycle where perceived lack of control reinforced global helplessness, maintaining symptom severity and preventing therapeutic engagement with traditional approaches.
The Process
To counteract the External Locus of Control pattern, the hypnotic device of Skill Building was utilised to transfer agency back to the client through the development of specific, measurable competencies. The mechanism of action involved replacing passive victimhood narratives with active mastery experiences, thereby shifting the locus of control from external to internal through demonstrable capability development.
The protocol commenced with an Elman induction to achieve rapid hypnotic depth, followed by a Progressive Muscle Relaxation deepener to establish somatic awareness and control. The primary intervention employed Skill Building through guided imagery of successful social interactions, with specific emphasis on the client's active choices, responses, and influence within each scenario. This was complemented by Reframing techniques that restructured the meaning of social anxiety from 'evidence of personal inadequacy' to 'information about values and standards.'
Session one focused on workplace meeting scenarios, where the client was guided through detailed visualisations of contributing meaningfully to discussions, recognising her expertise, and observing others' positive responses to her input. Post-hypnotic suggestions emphasised her capacity to choose her focus, regulate her breathing, and access her professional competence regardless of external circumstances.
Session two expanded the skill building to encompass broader social contexts, utilising metaphorical frameworks of personal authority and choice. The client was guided to experience herself as the director of her own responses, with anxiety reframed as valuable information about her commitment to excellence rather than evidence of inadequacy.
To facilitate neuroplasticity through repetition and reinforcement, the client was provided with a digital audio recording of the session and instructed to listen daily between appointments. This ensured the 'dose' of the therapeutic suggestion was maintained outside the clinical setting, enabling continuous pattern restructuring through regular exposure to the new cognitive frameworks and skill-based approaches.
The Result
Quantitative outcomes demonstrated substantial improvement across all measured domains following the 2-session intervention:
| Measure | Baseline | Mid-Treatment | Post-Treatment | % Change |
|---|---|---|---|---|
| DASS-21 (Anxiety) | 14 | 10 | 4 | 71% |
| DASS-21 (Stress) | 10 | 6 | 4 | 60% |
| DAS (Cognitive Distortion) | 129 | 87 | 54 | 58% |
| SUDS (0-10) | 8 | 6 | 0 | 100% |
The most significant change occurred in subjective distress levels, with SUDS reducing from 8 to 0, representing complete resolution of subjective anxiety during social situations. DASS-21 Anxiety scores decreased from severe (14) to normal (4) range, whilst stress levels similarly normalised. The substantial reduction in DAS scores from 129 to 54 indicated successful cognitive restructuring and the development of more adaptive thought patterns.
Qualitatively, the client reported a fundamental shift in her relationship with social situations: 'I never realised I had so much choice in how I respond to people. Now when I feel that familiar anxiety starting, I remember that I can choose where to put my attention and what to focus on. It's like I've discovered I was already competent - I just needed to remember how to access it. The anxiety still comes sometimes, but now it feels like information rather than evidence that something's wrong with me.'
Introduction
Clinical data shows that 7.1% of Australians experience social anxiety, with the condition involving intense fear of social situations that significantly affects daily interactions and quality of life through overwhelming worry about judgement. In professional environments, social anxiety presents unique challenges, particularly for individuals in leadership roles who must regularly engage in public speaking, conduct meetings, and navigate complex workplace dynamics. Research demonstrates that social anxiety has increased by 30% since 2020, with common triggers including public speaking (89%), meeting new people (76%), eating in public (65%), and workplace interactions (58%).
Among young Australians aged 16-24, the prevalence rises to 12.1%, suggesting a growing cohort entering the workforce with established social anxiety patterns. For professionals in managerial positions, the condition can severely compromise career advancement and organisational effectiveness. Traditional cognitive behavioural approaches often require extensive treatment duration, highlighting the need for efficient, targeted interventions.
The present case study aims to demonstrate the efficacy of clinical hypnotherapy in shifting External Locus of Control patterns and reducing symptom severity through targeted Skill Building and Reframing interventions in a professional context.
Case Presentation
The client was a 61-year-old female manager residing in Boonooroo Plains, Queensland, who sought hypnotherapeutic intervention for social anxiety that was significantly impacting her professional performance and personal wellbeing. She presented with a 15-year history of workplace anxiety, describing herself as feeling 'completely at the mercy of other people's opinions' and believing that her emotional state was entirely dependent on external validation.
The client's presenting complaint centred on intense anxiety during workplace interactions, particularly team meetings, performance reviews, and client presentations. She reported: 'I feel like I have no control over how I react when people are watching me. It's like my anxiety just happens to me, and there's nothing I can do about it. I've tried everything, but nothing works because I'm just not the type of person who can handle pressure.'
Psychometric assessment revealed significant symptom severity across multiple domains. DASS-21 Anxiety scored 14, indicating severe anxiety levels. DASS-21 Stress measured 10, reflecting moderate stress levels. The Dysfunctional Attitude Scale (DAS) scored 129, indicating highly elevated dysfunctional attitudes and cognitive distortions. Subjective Units of Distress (SUDS) rated 8 on a 0-10 scale, indicating severe subjective distress during social situations.
Clinical formulation identified a complex psychological pattern characterised by External Locus of Control combined with Global Attribution style. The client consistently attributed her anxiety responses to external factors beyond her control whilst simultaneously generalising these experiences across all social contexts. This pattern was further supported by the elevated DAS score, indicating pervasive cognitive distortions about personal agency and capability. The client demonstrated Stable Attribution patterns, viewing her social anxiety as a permanent personality trait rather than a manageable condition, which explained her sense of learned helplessness and treatment resistance.
Discussion
The substantial improvements observed in this case study can be understood through the lens of neuroplasticity and targeted pattern modification. The daily audio repetition facilitated the rewiring of established neural pathways associated with External Locus of Control, enabling the development of new neural networks supporting internal agency and personal mastery. This neuroplastic change was measurably reflected in the 58% reduction in DAS scores, indicating fundamental cognitive restructuring at the level of core beliefs and attitudes.
From a Polyvagal Theory perspective, the intervention supported a shift from chronic sympathetic arousal (characteristic of social anxiety) to ventral vagal safety through the development of perceived personal competence and control. The client's newfound ability to access her professional expertise and make active choices during social interactions activated the social engagement system, enabling calm, confident interpersonal functioning.
The mechanism of change appears to have operated through the specific targeting of the External Locus of Control pattern. By systematically building evidence of personal agency through guided skill development, the intervention directly contradicted the client's core belief that her responses were entirely determined by external factors. The measured drop in DASS-21 Anxiety scores from 14 to 4 represents a shift from severe clinical symptoms to normal range functioning, achieved through the restoration of perceived personal control rather than symptom management alone.
These findings align with research by Schoenberger et al. (1997, Behaviour Therapy) demonstrating the effectiveness of hypnotherapy for social anxiety through cognitive restructuring techniques. The results also support recent meta-analyses by Golden et al. (2012, International Journal of Clinical and Experimental Hypnosis) showing significant symptom reduction in anxiety disorders through targeted hypnotic interventions. The rapid treatment response observed in this case is consistent with clinical trial data indicating 75-85% success rates for hypnotherapy in social anxiety management within 2-5 sessions.
Conclusion
This case study demonstrates the clinical efficacy of targeted hypnotherapeutic intervention in addressing social anxiety through psychological pattern modification. The successful shift from External to Internal Locus of Control, achieved through Skill Building and Reframing techniques, resulted in clinically significant improvements across multiple outcome measures within 2 sessions. These findings support the integration of pattern-specific hypnotherapy approaches in clinical practice for social anxiety management, particularly for professionals requiring rapid, effective intervention. The substantial improvement in functional outcomes suggests that addressing core psychological patterns may be more efficient than traditional symptom-focused approaches, warranting further research in occupational mental health contexts.
The author is a clinical hypnotherapist, not a medical doctor. This case study reports on the management of symptoms and behavioural patterns and does not constitute a medical diagnosis. DASS/DAS scores are used for tracking therapeutic progress, not psychiatric diagnosis.
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