Breaking Through the Quiet: Confronting Social Anxiety in School

Dr. Moses Appel (edited by Matthew Shields)

"We're worried about Chaim," the principal gently tells the Liebowitz parents. 

"Is he causing trouble?" his mom asks, frowning. "I knew setting his bedtime after nine wasn't good for him." 

"No, no, nothing like that," the principal reassures her, raising a hand. "Chaim's a good kid. He's bright and has respectable middos." 

"So, what's the problem, then?" asks Chaim's father, glancing at his watch. He had left work at 11 a.m. during tax season to attend this meeting, and the uncertainty has made him impatient. 

The principal leans forward. "It may be in your best interest to have Chaim see a therapist. I’m not sure if he’s on the autism spectrum or if his confidence has been shaken, but his shyness concerns me."

"Shyness?" Chaim’s mother repeats, confused.

"Yes, he doesn’t speak in shiur, even when asked directly. During recess, Chaim stays inside while the other boys are outside playing ball." The principal hesitates. "And…I’m not sure how to tell you this, but when I asked him if he needed to use the restroom after a class trip, he told me he can't if others are in there with him."

Chaim’s father frowns. Could this be true? He wonders. Chaim’s always been so outgoing at home. The Shabbos table is his stage. His siblings can’t compete with his jokes. It didn’t make sense hearing this from the principal.

Then it clicks. Wait… maybe it’s not all that surprising. His mind flashes to moments he had brushed off. Chaim's always been quiet around the shul rav. I thought it was a sign of kavod, but maybe it’s more than that. And what about those awkward playdates? We thought he just didn’t like the other kids—but maybe… 

Mr. Liebowitz sits back in his chair. This isn’t new, is it? We just never saw it. Chaim’s mother looks over at him, her eyes wide, and he knows she’s putting the pieces together, too. 

"This is why Chaim hates going on playdates," she murmurs, almost to herself. "We thought he just preferred to be home. It’s more than that, isn’t it?" 

The principal nods gently. "It seems so." 

Mr. and Mrs. Liebowitz leave the meeting knowing that Chaim needs help. They ask the principal to recommend them a therapist and set up an appointment.

A Diagnosis: Social Anxiety Disorder (SAD)

The therapist gets to know Chaim, although getting the child to open up takes time and effort. After a few sessions, the psychologist relays to the Liebowitz parents that Chaim struggles with Social Anxiety Disorder (SAD).

He gently explains,  "Two diagnostic criteria define Social Anxiety Disorder. First, there must be a fear or anxiety of social situations in which it's possible to be scrutinized by others. This can manifest in many ways, such as when speaking in public, going to parties, and eating in front of others.  Chaim’s SAD appears in a few core situations: avoiding using the bathroom, not participating in recess, and Chaim's silence in shiur.

"But he’s so outgoing at home," Mr. Liebowitz interrupts, his brows knitting together. "Is it possible for him to be so different at school?"

"It’s common," the therapist replies. "Social anxiety can show up in very specific situations—like at school or in groups—but not always in familiar, comfortable environments like home." 

"So, it's only a problem in certain places," Chaim’s mother interjects. "But it’s enough to worry about?"

"Yes," the therapist nods. "The second criterion is that the person either avoids these situations or endures them with intense fear or anxiety. Chaim avoids settings where his social anxiety might become triggered, like going outside during recess, and endures certain situations under a lot of stress, like going to shul. We need to explore which situations he’s avoiding and which he’s enduring with significant distress." 

The therapist glances at the parents’ concerned faces before continuing. "The bottom line is that the core of Social Anxiety Disorder is a fear of negative evaluation—being afraid of what others think. Given that we’re social creatures by nature, SAD can be debilitating." 

Exploring Treatment Options

Mrs. Liebowitz sighs.  "What’s the difference between this disorder and just being shy? Lots of kids are shy." 

"Shyness isn’t a pathological disorder, but a personality trait. We usually diagnose a person with SAD when there’s significant functional impairment or clinical distress in social situations. In fact, only about twelve percent of shy people meet the criteria for Social Anxiety Disorder." 

Mr. and Mrs. Liebowitz exchange glances. "So, what’s the plan for Chaim? How do we fix this?" Mr. Liebowitz asks.

"Our goal is to manage Chaim's social anxiety so that it's not so debilitating," the therapist explains, leaning forward. "There are no methods that can completely eradicate social anxiety disorder. However, we have a few therapeutic approaches that can help. I’ll explain each one, and then together, the four of us—Chaim included—can decide on the best course of action." 

Cognitive Behavioral Therapy (CBT)

"The first therapeutic approach is Cognitive Behavioral Therapy (CBT). This method is based on the idea that what we think and do affects how we feel. For example, Chaim avoids using the bathroom at school. This affects him physically, but it also amplifies his anxiety. Avoidance reinforces his fears and makes the problem worse."

Mr. Liebowitz nods slowly.  "Okay, I follow you so far."

"The opposite is also true," the therapist continues. "If we can help Chaim to face these situations and adjust his thoughts, his anxiety will start to diminish. One tool we use in CBT is a thought record." 

Mrs. Liebowitz leans in, looking more interested now.  "How does that work?" 

"Let’s use the recess example. I’ll have Chaim go out and play with his friends during recess at school at least once daily. He’ll write down how he feels physically, behaviorally, and cognitively before and after. For instance, how does his anxiety manifest physically? What does he actually do during recess? What thoughts go through his mind? Then, we can encourage Chaim to systematically change his thinking patterns so that he thinks more realistically, which will make it easier for him to change his behavior (approach instead of avoid), and ultimately change the way he feels as well!"

Rational Emotive Behavioral Therapy (REBT)

"The second approach is Rational Emotive Behavioral Therapy (REBT). This method focuses on identifying and challenging irrational beliefs. It’s a bit different from CBT because it goes deeper into the underlying beliefs behind Chaim’s anxieties. In REBT, we use the ABC model."

"ABC?" Mrs. Liebowitz asks, intrigued.

"Yes, ABC stands for Activating events, Beliefs, and Consequences. An activating event triggers beliefs, which then lead to emotional consequences. For instance, let's say Chaim’s friends criticize his basketball skills, and Chaim thinks, 'My friends say I am bad at sports, so I am worthless' That’s the core belief. The consequence of that belief is Chaim’s intense anxiety."

"And this is different from CBT?" Mr. Liebowitz asks.

"Yes," the therapist explains. "While CBT focuses more on the automatic thoughts, REBT digs deeper into those underlying beliefs. In REBT, we challenge those beliefs head-on. For example, we might ask Chaim, 'Just because your friends criticize your basketball skills, does that mean that you are worthless? Who cares if they criticize your basketball skills? Can you learn to just say “so what”?' It’s about helping Chaim challenge and reframe those core beliefs, and learn to care less, which will make it easier for him to engage in more activities and feel less anxious."

Acceptance and Commitment Therapy (ACT)

"The third is Acceptance and Commitment Therapy (ACT). This method focuses on helping Chaim live in alignment with his values, even while experiencing anxiety. We work on accepting his anxious feelings, and changing his relationship with his thoughts, so that they lose some of their power and stop controlling his actions. One of the key techniques in ACT is called Cognitive Defusion, where Chaim would learn to see his anxious thoughts as just thoughts—nothing more."

Conclusion

A few months later, Mr. and Mrs. Liebowitz meet with the principal once again.

"It's like he's a brand-new kid," the principal says, beaming. "His rebbe tells me he's one of the most active kids in the classroom. He’s developed a solid three-point shot in basketball, and the other kids love having him on their team. Most importantly, he seems comfortable. We’re proud to have Chaim in our school."

Disclaimer: All characters in this post are entirely fictional. This content is intended for informational purposes only and is not a substitute for professional therapy or treatment from a licensed mental health provider. To contact Dr. Appel, please email office@ADOPsychologyCenter.com.