Social anxiety significantly impacts daily functioning and quality of life through overwhelming worry about judgement in social situations. This single-case study examines the application of clinical hypnotherapy in addressing social anxiety through cognitive restructuring of external locus of control and negative expectancy patterns. A 26-year-old male teacher presented with elevated scores on standardised measures: DASS-21 Anxiety (12), DASS-21 Stress (15), DAS (127), and SUDS (8). The intervention utilised reframing and reality checking hypnotic devices across three sessions to restructure dysfunctional cognitive patterns. Post-treatment outcomes demonstrated significant improvements: DASS-21 Anxiety reduced to 2 (83% improvement), DASS-21 Stress to 4 (73% improvement), DAS to 64 (50% improvement), and SUDS to 2 (75% improvement). The findings support the efficacy of targeted hypnotherapeutic interventions in addressing the cognitive underpinnings of social anxiety.
The Challenge
The primary therapeutic challenge involved addressing the client's deeply entrenched external locus of control, which positioned him as a passive recipient of social experiences rather than an active agent capable of influencing outcomes. This cognitive pattern was reinforced by his negative expectancy bias, whereby he automatically anticipated negative judgement and rejection in social situations. The client's magnifying perceptual style amplified minor social cues into perceived threats, whilst his stable attributional style positioned these experiences as unchangeable aspects of his personality rather than modifiable responses.
The Process
The intervention targeted the restructuring of the client's external locus of control through the strategic application of reframing and reality checking hypnotic devices. To counteract the external locus of control, reframing was utilised to transfer agency back to the client by repositioning social interactions as skill-based activities subject to improvement and mastery. Reality checking served to challenge the accuracy of catastrophic predictions and introduce evidence-based perspectives on social encounters.
The protocol commenced with progressive muscle relaxation induction, followed by a metaphorical deepener involving a journey through a garden where the client learned to tend different plants with varying needs, representing the diversity of social situations requiring different approaches. Each session incorporated response sets utilising truisms about human connection and social learning, followed by leading statements about personal growth and capability.
Session content focused on cognitive restructuring through reframing techniques that repositioned social anxiety as a protective mechanism that had become overactive rather than a fixed personality trait. Reality checking exercises involved guided imagery where the client observed social interactions from multiple perspectives, recognising the subjective nature of social judgements and the limited accuracy of mind-reading assumptions. Post-hypnotic suggestions were embedded to automatically trigger resource states during social encounters, with specific anchors for confidence and curiosity replacing anxiety and avoidance.
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, allowing for consolidation of new neural pathways and cognitive patterns.
The Result
Quantitative outcomes demonstrated substantial improvements across all measured domains, with particularly pronounced changes in anxiety-specific measures:
| Measure | Baseline | Mid-Treatment | Post-Treatment | % Change |
|---|---|---|---|---|
| DASS-21 (Anxiety) | 12 | 9 | 2 | 83% |
| DASS-21 (Stress) | 15 | 8 | 4 | 73% |
| DAS (Cognitive Distortion) | 127 | 92 | 64 | 50% |
| SUDS (0-10) | 8 | 4 | 2 | 75% |
Qualitative outcomes were equally encouraging, with the client reporting: 'I now see social situations as opportunities to connect rather than threats to survive. I realise that most people are focused on their own concerns rather than judging me, and even if someone does judge me negatively, that says more about them than about me. I feel like I have tools now rather than just hoping for the best.'
The client demonstrated sustained improvements at two-week follow-up, with maintained low anxiety scores and reported confidence in managing social challenges independently. He described returning to social activities he had avoided for years and expressed satisfaction with his professional interactions.
Introduction
Social anxiety disorder represents one of the most prevalent mental health concerns in contemporary Australian society. In the region of Glen Davis, mental health surveillance indicates 7.1% of Australians experience social anxiety, with youth prevalence reaching 12.1% among those aged 16-24. This condition involves intense fear of social situations, affecting daily interactions and quality of life through overwhelming worry about judgement. Since 2020, there has been a 30% increase in social anxiety presentations, with common triggers including public speaking (89%), meeting new people (76%), eating in public (65%), and workplace interactions (58%).
Clinical hypnotherapy offers a non-pharmacological intervention approach that addresses the cognitive and behavioural patterns underlying social anxiety. The approach focuses on restructuring maladaptive thought patterns and enhancing psychological resources through targeted therapeutic techniques. This case study aims to demonstrate the efficacy of clinical hypnotherapy in shifting the client's external locus of control and negative expectancy patterns whilst reducing symptom severity through measurable outcomes.
Case Presentation
The client was a 26-year-old male teacher residing in Glen Davis, New South Wales, who presented with longstanding social anxiety affecting his professional and personal functioning. He reported experiencing intense anticipatory anxiety before social interactions, particularly in professional settings, accompanied by physical symptoms including rapid heartbeat, sweating, and trembling. The client described his anxiety as 'completely controlling my life' and expressed frustration at feeling powerless to change his responses.
Psychometric assessment revealed significant elevations across multiple domains. The DASS-21 Anxiety subscale score of 12 indicated moderate anxiety levels, whilst the DASS-21 Stress subscale score of 15 demonstrated elevated stress responses. The Dysfunctional Attitude Scale (DAS) score of 127 indicated pronounced cognitive distortions and rigid thinking patterns. The client's Subjective Units of Distress Scale (SUDS) rating of 8 reflected high subjective distress when contemplating social interactions.
Clinical formulation revealed a complex pattern of cognitive distortions characterised by an external locus of control and negative expectancy orientation. The client consistently attributed social outcomes to external factors beyond his influence, demonstrating a stable attribution style whereby social difficulties were viewed as permanent personality traits. This was compounded by a global attribution pattern, whereby isolated social challenges were generalised across all interpersonal contexts. Assessment revealed a pronounced tendency towards magnifying negative social cues whilst diminishing positive feedback, creating a self-reinforcing cycle of social avoidance and anxiety escalation.
Discussion
The substantial improvements observed in this case study support the efficacy of targeted cognitive restructuring through hypnotherapeutic intervention. The mechanism of change can be understood through the lens of neuroplasticity, whereby the daily repetition of therapeutic suggestions via audio recording facilitated the consolidation of new neural pathways supporting adaptive cognitive patterns. The reframing device specifically addressed the client's external locus of control by repositioning social experiences as learnable skills rather than immutable traits, whilst reality checking challenged the accuracy of catastrophic social predictions.
From a polyvagal perspective, the intervention facilitated a shift from chronic sympathetic arousal associated with social threat detection to ventral vagal engagement supporting social connection and curiosity. This was evidenced by the dramatic reduction in DASS-21 Anxiety scores from 12 to 2, representing a fundamental alteration in the client's physiological and psychological response to social stimuli.
The 50% reduction in DAS scores from 127 to 64 indicates successful restructuring of the underlying cognitive distortions that maintained the social anxiety cycle. This cognitive shift enabled the corresponding reduction in subjective distress (SUDS reduction from 8 to 2) and overall stress responses (DASS-21 Stress reduction from 15 to 4). These findings align with research by Schoenberger et al. (1997, Behaviour Therapy) demonstrating the effectiveness of hypnotic enhancement in cognitive behavioural interventions for social anxiety, and Golden et al. (2012, International Journal of Clinical and Experimental Hypnosis) highlighting the specific efficacy of hypnotherapy for anxiety disorders.
The case demonstrates the importance of targeting specific psychological patterns rather than symptomatic presentations alone. By addressing the client's external locus of control and negative expectancy bias, the intervention created sustainable change that extended beyond symptom management to fundamental cognitive restructuring.
Conclusion
This case study demonstrates the clinical efficacy of targeted hypnotherapeutic intervention in addressing social anxiety through cognitive restructuring of maladaptive psychological patterns. The substantial improvements across multiple outcome measures support the integration of clinical hypnotherapy within contemporary mental health treatment approaches. The findings suggest that addressing specific cognitive distortions through hypnotic devices can create lasting therapeutic change within brief treatment timeframes. Future research should explore the replication of these findings across diverse populations and the long-term stability of therapeutic gains achieved through hypnotherapeutic cognitive restructuring.
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.
Ready to Begin Your Own Journey?
If you're experiencing similar challenges with social anxiety, we're here to help. Book a free consultation to discuss how hypnotherapy can support you.