Learning to Handle Emotions First: The Key to Overcoming Social Anxiety
New research reveals that improving emotion regulation skills during therapy helps predict better outcomes for people with social anxiety disorder.
When Marcus started online therapy for his social anxiety, he had no idea that learning to manage his emotions would be more important than tackling his fear of public speaking directly. Like many people with social anxiety, Marcus assumed therapy would focus mainly on challenging his anxious thoughts and gradually facing feared situations. What surprised him was discovering that his ability to handle difficult emotions in general turned out to be a crucial factor in his recovery.
Marcus's experience reflects findings from a study that followed 46 people with social anxiety disorder through nine weeks of internet-based cognitive behavioural therapy and continued tracking their progress for over two years afterward. The research revealed a fascinating pattern: people who improved their emotion regulation skills during therapy were more likely to see their social anxiety symptoms decrease in the weeks and months that followed.
Understanding Emotion Regulation
Emotion regulation refers to the various ways we monitor, evaluate, and manage our emotional responses to different situations. It's not about suppressing or avoiding emotions, but rather developing healthy skills for dealing with them when they arise.
People with good emotion regulation can:
- Recognize and understand their emotions as they occur
- Stay focused on their goals even when experiencing distress
- Control impulsive behaviors when upset
- Access effective strategies for managing difficult emotions
- Accept their emotions without judgment
- Maintain emotional clarity rather than feeling overwhelmed
For people with social anxiety disorder, emotion regulation can be particularly challenging. They may struggle with intense feelings of fear, embarrassment, or shame in social situations, and often lack effective tools for managing these overwhelming emotions.
The Social Anxiety Connection
Social anxiety disorder affects millions of people worldwide, causing intense fear and avoidance of social situations due to worry about being judged, embarrassed, or rejected by others. People with this condition often experience physical symptoms like racing heart, sweating, trembling, or blushing, which can further increase their anxiety and self-consciousness.
Research has consistently shown that people with social anxiety tend to have more difficulties with emotion regulation compared to those without the condition. They may rely heavily on strategies like emotional suppression (trying to hide their feelings) or avoidance, which can provide temporary relief but often make the problem worse over time.
The Study Design
The researchers recruited participants with social anxiety disorder from northern Sweden through social media advertisements. All participants met the criteria for social anxiety as their primary diagnosis and were generally functioning well in their daily lives, though many had additional mental health conditions.
What made this study unique was its comprehensive approach to measurement. Rather than just looking at before and after therapy results, the researchers tracked participants at seven different time points over 28 months:
- Two baseline measurements (11 weeks apart before therapy began)
- Mid-treatment (4 weeks into therapy)
- Post-treatment (after 9 weeks)
- 6-month follow-up
- 12-month follow-up
- 28-month follow-up
This extensive timeline allowed researchers to see not just whether therapy worked, but how the relationship between emotion regulation and social anxiety symptoms evolved over time.
The Internet-Based Therapy Program
Participants received a nine-week internet-based cognitive behavioural therapy program that had been proven effective in previous studies. Each week, they worked through online modules containing educational materials and homework assignments based on CBT principles.
The program followed a structured approach:
Weeks 1-4: Cognitive Focus
- Learning about social anxiety and its patterns
- Practicing cognitive restructuring (challenging anxious thoughts)
- Conducting behavioral experiments to test problematic beliefs
Weeks 5-9: Behavioral Focus
- Introduction of exposure exercises (gradually facing feared situations)
- Continued practice with cognitive techniques
- Integration of skills learned throughout therapy
Throughout the program, participants had weekly contact with clinical psychologists who provided written feedback and guidance through the secure online platform.
Key Findings
The study revealed several important patterns that have significant implications for understanding and treating social anxiety:
Emotion Regulation Improves First: One of the most interesting discoveries was the timing of improvements. Participants showed the largest improvements in emotion regulation during the first half of therapy (weeks 1-4), while the biggest reductions in social anxiety symptoms occurred during the second half (weeks 5-9).
This pattern suggests that developing better emotion regulation skills may create a foundation that allows people to benefit more fully from exposure exercises and other anxiety-specific interventions later in therapy.
Individual Changes Matter Most: The research used sophisticated statistical methods to separate individual-level changes from group-level patterns. The results showed that when individuals improved their emotion regulation skills, they were more likely to see subsequent reductions in their social anxiety symptoms.
Importantly, this relationship worked in one direction: better emotion regulation predicted later improvements in social anxiety, but early improvements in social anxiety didn't predict later emotion regulation gains. This suggests that emotion regulation may be a key mechanism through which therapy helps people overcome social anxiety.
Long-Term Benefits: The positive effects of therapy lasted throughout the entire 28-month follow-up period. Participants maintained their gains in both emotion regulation and social anxiety symptoms, suggesting that the skills learned during the relatively brief nine-week program had lasting benefits.
Reliable Measurements: The study confirmed that both emotion regulation difficulties and social anxiety symptoms could be measured reliably over time, giving confidence in the accuracy of the findings.
Why Emotion Regulation Matters
The findings help explain why some people respond better to social anxiety treatment than others. People who develop better emotion regulation skills during therapy may be better equipped to:
Handle the discomfort of exposure exercises: Facing feared social situations is inherently uncomfortable. Better emotion regulation skills help people tolerate this discomfort and stay engaged with therapeutic exercises.
Recover from setbacks: Social anxiety treatment involves ups and downs. People with good emotion regulation skills may bounce back more quickly from difficult experiences and maintain their motivation for change.
Apply skills in real-world situations: Managing social anxiety in daily life requires the ability to regulate emotions as they arise. People who develop these skills during therapy are better prepared to handle challenging social situations independently.
Break cycles of avoidance: Social anxiety is often maintained by patterns of avoidance. Better emotion regulation provides alternatives to avoidance when facing difficult emotions.
Practical Implications
For people considering treatment for social anxiety, this research suggests several important points:
Emotion regulation skills are learnable: The study showed that people with social anxiety can significantly improve their emotion regulation abilities through cognitive behavioral therapy, even in an online format.
Early therapy work matters: The cognitive exercises and skills taught in the first half of therapy may be more important than they initially appear. These foundational skills create the groundwork for later success.
Individual progress varies: The research emphasized that changes happen differently for each person. What matters most is individual improvement relative to one's own baseline, not comparison to others.
Online therapy can be effective: The internet-based format proved highly effective, offering hope for people who may not have access to in-person therapy or prefer the convenience and privacy of online treatment.
Long-term benefits are possible: The lasting effects seen over more than two years suggest that relatively brief interventions can create enduring positive changes.
The Treatment Timeline
Understanding when different changes typically occur during therapy can help both therapists and clients set realistic expectations:
Early Phase (Weeks 1-4): Focus on building emotion regulation skills through cognitive techniques, psychoeducation, and behavioural experiments. People may notice improved ability to manage emotions even before social anxiety symptoms significantly decrease.
Later Phase (Weeks 5-9): Introduction of exposure exercises, building on the emotion regulation foundation established earlier. This is typically when the most significant reductions in social anxiety symptoms occur.
Follow-up Period: Continued practice and application of skills in real-world situations, with benefits typically maintained or even continuing to improve over time.
This research contributes to a growing understanding that adequate mental health treatment often involves addressing general emotional and coping skills rather than focusing solely on specific symptoms. The findings suggest that:
Emotion regulation may be a common pathway through which various therapies work: Even though this study focused on social anxiety, the principles may apply to other conditions where emotion regulation difficulties play a role.
Therapeutic interventions may have sequential effects: Different components of therapy may work in a specific order, with some skills providing the foundation for others to be effective.
Individual-level monitoring is valuable: Tracking how individual clients are progressing in their emotion regulation skills during therapy could help therapists identify who may need additional support or different approaches.
The researchers noted several directions for future investigation:
More frequent measurements: Using techniques like ecological momentary assessment (smartphone-based tracking) could provide more detailed information about how emotion regulation and social anxiety interact day-to-day.
Component analysis: Future studies could examine whether specific emotion regulation skills are more important than others for social anxiety treatment outcomes.
Different populations: Testing these findings with more diverse groups of people could help determine how broadly the results apply.
Intervention development: The findings could inform the development of new treatments that more explicitly target emotion regulation skills as a pathway to reducing social anxiety.
For people struggling with social anxiety like Marcus, this research offers both practical insights and reason for optimism. The study demonstrates that social anxiety is highly treatable, that online therapy can be just as effective as traditional approaches, and that the benefits of treatment can last for years.
Perhaps most importantly, the research helps explain why therapy works: by teaching people better ways to handle difficult emotions, treatment creates a foundation for facing fears and building confidence in social situations. Rather than viewing emotion regulation and social anxiety as separate issues, this study shows they're intimately connected, with improvements in one leading to benefits in the other.
The findings suggest that people don't need to choose between addressing their emotions or tackling their social fears directly. Instead, working on emotion regulation skills first may actually make it easier to face social challenges later. For the millions of people affected by social anxiety, this research points toward more effective, accessible, and hope-filled approaches to recovery.
Garke, M. Å., Hentati Isacsson, N., Kolbeinsson, Ö., Hesser, H., & Månsson, K. N. (2025). Improvements in emotion regulation during cognitive behavior therapy predict subsequent social anxiety reductions. Cognitive Behaviour Therapy, 54(1), 78-95.
