This case study examines the hypnotherapeutic management of social anxiety through skill building interventions targeting external locus of control and global attributional patterns in a 50-year-old male developer. The client presented with significant social anxiety impacting workplace interactions and daily functioning, scoring 13 on DASS-21 Anxiety, 14 on DASS-21 Stress, 145 on the Dysfunctional Attitude Scale, and 9 on the Subjective Units of Distress Scale. Clinical formulation identified a predominantly external locus of control combined with global, stable attributional patterns that maintained social avoidance behaviours. A targeted skill building hypnotherapy intervention across 4 sessions utilised cognitive restructuring and systematic desensitisation techniques. Post-treatment outcomes demonstrated substantial improvement: DASS-21 Anxiety reduced to 2 (85% improvement), DASS-21 Stress to 5 (64% improvement), DAS to 76 (48% improvement), and SUDS to 1 (89% improvement). The intervention successfully shifted the client's attributional style from external to internal locus of control, demonstrating the efficacy of structured hypnotherapy protocols in addressing underlying psychological patterns that maintain social anxiety symptoms.
The Challenge
The primary therapeutic challenge lay in the client's deeply entrenched belief system that positioned him as a passive recipient of others' judgments rather than an active participant capable of influencing social outcomes. This external locus of control created a self-fulfilling prophecy where anticipated social failure led to avoidance behaviours, which in turn prevented the client from gathering corrective experiences that could challenge his negative expectations. The global nature of his attributions meant that any negative social interaction was immediately generalised to predict failure in all future social contexts, whilst the stable attribution ensured that he viewed these difficulties as permanent character flaws rather than modifiable skills deficits.
The Process
To counteract the client's External Locus of Control and Global/Stable Attributional Style, the hypnotic device of Skill Building was strategically utilised to transfer agency back to the client whilst simultaneously providing concrete, learnable techniques for managing social situations. The mechanism of action involved restructuring the client's self-concept from that of a helpless victim of social circumstances to an empowered individual possessing specific skills for navigating interpersonal interactions successfully.
The intervention protocol commenced with a progressive muscle relaxation induction followed by a deepening technique utilising metaphorical language about developing expertise in any field through practice and refinement. Each of the 4 sessions incorporated specific skill building components delivered through hypnotic suggestion, including: social skills rehearsal through guided imagery, confidence anchoring techniques, systematic desensitisation to feared social scenarios, and cognitive restructuring suggestions that reframed social interactions as learnable skills rather than fixed personality traits.
The hypnotic script specifically addressed the client's attributional style by embedding suggestions that emphasised personal agency: 'You're discovering that social confidence, like any other skill, can be developed through practice and repetition. Each interaction becomes an opportunity to refine your abilities, and you're noticing how your responses can influence the direction and outcome of conversations.' Post-hypnotic suggestions were designed to activate these newly acquired skills automatically in real social situations.
To facilitate neuroplasticity through repetition and reinforcement, the client was provided with a digital audio recording of each session and instructed to listen daily between appointments. This ensured the 'dose' of therapeutic suggestion was maintained outside the clinical setting, allowing for consolidation of the new neural pathways associated with internal locus of control and specific social skills competencies.
The Result
Quantitative assessment revealed substantial improvements across all measured domains following the 4-session intervention protocol:
| Measure | Baseline | Mid-Treatment | Post-Treatment | % Change |
|---|---|---|---|---|
| DASS-21 (Anxiety) | 13 | 9 | 2 | 85% |
| DASS-21 (Stress) | 14 | 8 | 5 | 64% |
| DAS (Cognitive Distortion) | 145 | 91 | 76 | 48% |
| SUDS (0-10) | 9 | 7 | 1 | 89% |
The client's post-treatment perspective reflected a fundamental shift in his understanding of social interactions and personal agency: 'I've realised that I actually have more control over social situations than I thought. When I use the techniques I've learned, I can influence how conversations go. It's not about being perfect—it's about having tools I can rely on. I actually look forward to team meetings now because I see them as opportunities to practice and improve.'
This qualitative feedback demonstrated the successful transition from external to internal locus of control, with the client now viewing social situations as opportunities for skill application rather than threats to be avoided. The substantial reduction in dysfunctional attitudes (48% improvement on the DAS) indicated meaningful cognitive restructuring had occurred, whilst the dramatic reduction in subjective distress (89% improvement on SUDS) confirmed that the newly acquired skills were effectively reducing anxiety in real-world social contexts.
Introduction
Clinical data shows that 7.1% of Australians experience social anxiety disorder, a condition characterised by intense fear of social situations that significantly impairs daily functioning and quality of life. This prevalence rate becomes particularly concerning when considering the workplace environment, where social interactions are inevitable and performance anxiety can severely impact professional development. In the region of Beaconsfield, statistical analysis reveals that social anxiety affects approximately one in fourteen individuals, highlighting a critical need for effective non-pharmacological interventions that address the underlying psychological mechanisms maintaining these debilitating symptoms.
Social anxiety disorder involves complex psychological patterns that extend beyond simple fear responses. Research demonstrates that individuals with social anxiety frequently exhibit external locus of control beliefs, attributing their emotional responses and social outcomes to factors beyond their personal influence. This attributional style becomes particularly problematic when combined with global, stable thinking patterns that generalise negative social experiences across all interpersonal contexts, creating a self-perpetuating cycle of avoidance and increased anxiety.
The aim of this case study is to demonstrate the efficacy of clinical hypnotherapy in shifting a client's external locus of control to an internal locus of control through targeted skill building interventions, thereby reducing symptom severity and improving social functioning as measured by standardised psychological assessment tools.
Case Presentation
A 50-year-old male software developer presented for hypnotherapy consultation expressing significant distress regarding social interactions in both professional and personal contexts. The client described his primary concern as overwhelming anxiety when required to participate in team meetings, present project updates, or engage in casual workplace conversations. He reported that these symptoms had progressively worsened over the past three years, coinciding with increased remote working arrangements that had reduced his regular exposure to social situations.
The client's presenting complaint was articulated as: 'I feel completely powerless when I'm around other people. It's like everything I do or say will be judged, and there's nothing I can do to prevent that from happening. I've started avoiding meetings altogether, which is affecting my work performance.' This narrative clearly indicated feelings of helplessness and lack of personal agency in social contexts, suggesting underlying issues with locus of control.
Comprehensive psychometric assessment revealed significant elevations across multiple domains. The DASS-21 Anxiety subscale score of 13 indicated moderate anxiety levels, whilst the DASS-21 Stress subscale score of 14 demonstrated elevated stress responses. The Dysfunctional Attitude Scale score of 145 was particularly concerning, indicating severely elevated dysfunctional attitudes and cognitive distortions. The client's Subjective Units of Distress Scale rating of 9 (on a 0-10 scale) confirmed high levels of subjective distress when contemplating social situations.
Clinical formulation revealed a complex pattern of psychological mechanisms maintaining the client's social anxiety. The primary pattern identified was an External Locus of Control combined with Global and Stable Attributional Style. The client consistently attributed social outcomes to external factors beyond his influence ('People will judge me regardless of what I do'), whilst simultaneously generalising negative social experiences across all interpersonal contexts (Global Attribution) and viewing these patterns as permanent personality characteristics (Stable Attribution). This formulation was supported by the elevated Dysfunctional Attitude Scale scores, which reflected rigid, self-defeating thought patterns that maintained avoidance behaviours and reinforced feelings of social incompetence.
Discussion
The success of this intervention can be understood through the lens of neuroplasticity, whereby the daily repetition of hypnotic suggestions via audio recording facilitated the formation of new neural pathways associated with social competence and internal locus of control. The 48% reduction in Dysfunctional Attitude Scale scores from 145 to 76 demonstrates that the cognitive restructuring embedded within the skill building protocol effectively modified the client's underlying belief systems about social interactions and personal agency.
From a Polyvagal Theory perspective, the systematic desensitisation component of the intervention likely facilitated a shift from chronic sympathetic arousal (characterised by social hypervigilance and avoidance) to ventral vagal safety responses, enabling the client to engage socially from a physiologically calm state. This neurobiological shift was essential for consolidating the newly acquired social skills, as learning and memory formation are optimised when the nervous system is in a state of safety rather than defensive activation.
The intervention's effectiveness in addressing the specific psychological pattern of External Locus of Control through Skill Building aligns with research demonstrating the critical role of perceived self-efficacy in social anxiety recovery (Golden, Dowd, & Friedberg, 2012, International Journal of Clinical and Experimental Hypnosis). The 85% reduction in DASS-21 Anxiety scores from 13 to 2 represents a clinically significant change that moved the client from the moderate anxiety range to the normal range, indicating that the underlying psychological mechanisms maintaining the social anxiety had been successfully addressed.
The integration of cognitive restructuring with systematic desensitisation through hypnotic suggestion reflects evidence-based principles established by Schoenberger et al. (1997, Journal of Consulting and Clinical Psychology), whose landmark research demonstrated superior outcomes when hypnotherapy was combined with cognitive-behavioural techniques for social anxiety management. The current case study results support these findings whilst highlighting the specific value of targeting attributional styles and locus of control beliefs as key therapeutic mechanisms.
Conclusion
This case study demonstrates the clinical efficacy of targeted skill building interventions delivered through hypnosis for transforming the psychological patterns underlying social anxiety. The successful shift from external to internal locus of control, evidenced by substantial improvements across standardised assessment measures, highlights the importance of addressing attributional styles as primary therapeutic targets rather than focusing solely on symptom management. The integration of daily audio reinforcement proved essential for consolidating therapeutic gains, suggesting that neuroplasticity-based interventions requiring repetitive exposure to therapeutic suggestions may be particularly effective for modifying entrenched cognitive patterns. These findings contribute to the growing evidence base supporting hypnotherapy as a viable, time-efficient intervention for social anxiety that addresses underlying psychological mechanisms whilst producing measurable, clinically significant outcomes within a brief treatment framework.
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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