社交焦虑障碍即社交恐惧症，是最常见的心理障碍之一，主要表现为担忧或恐惧在社交情境中被人观察与评价，伴随着对社交情境的回避倾向，以及社会功能的损害。社交焦虑障碍通常难以自愈，需及时接受心理治疗或药物治疗。目前针对社交焦虑障碍的一线干预方法为认知行为疗法，该疗法中的认知重构为主要起效机制，即通过改变社交焦虑者适应不良的图式以缓解其症状。本研究主要关注存在社交焦虑症状但未达到临床诊断标准的社交焦虑者。

       本研究拟将箱庭疗法引入对社交焦虑的一线干预方法中，通过发挥该疗法的内隐图式表达优势，完成原干预方法中最重要的认知重构部分，以此拓展一线干预方案。本研究的主要目的是探讨箱庭疗法结合认知行为疗法通过认知重构机制缓解社交焦虑的可行性与效果。本研究采用箱庭疗法的个案研究范式对一例社交焦虑者进行干预，自2022年11月开始，至2023年2月结束，共包含13次心理咨询与1次初始筛选访谈。咨询全程可依据来访者的变化分为四个阶段：开始阶段（1–2次）、问题探索阶段（3–6次）、自我表露阶段（7–9次）、实际暴露阶段（10–13次）。干预前后以《Liebowitz社交焦虑量表（LSAS）》、《社交苦恼与回避量表（SADS）》、《贝克抑郁量表（BDI）》、《贝克焦虑量表（BAI）》评估来访者的社交焦虑状态，并结合其主观报告分析干预的有效性。

       干预完成后，来访者的各项量表得分均有下降。其中LSAS的得分从57分降至35分（临界值内），SADS的得分从18分降至13分，BDI的得分从5分降至4分，BAI的得分从9分降至7分。来访者的主观报告反映其与社交焦虑相关的图式已发生积极转变，对特定社交情境的恐惧感明显缓解，干预效果较明显。

       回顾研究过程并分析结果，可对所用干预方法的起效机制做出如下解释：（1）结合了箱庭疗法与认知行为疗法的认知重构改变了来访者有关自我、社交、人生意义的图式。（2）自我图式的改变可间接但有效地改变来访者的社交表现。（3）使用认知行为疗法对来访者的症状进行个案概念化可有效确定认知重构的靶点。（4） 箱庭疗法有助于促使来访者觉察并改变自我图式。

       本研究的结论为：箱庭疗法可结合认知行为疗法对社交焦虑者进行认知重构，从而有效缓解其社交焦虑症状，且箱庭疗法有助于促使来访者觉察与改变自我图式。

       Social anxiety disorder (Social Phobia), is one of the most common psychological disorders. It is characterized by excessive fear and anxiety in social situations where one may be scrutinized or evaluated by others. It is characterized by excessive fear or anxiety of being scrutinized and evaluated by others in social situations, accompanied by a tendency to avoid social situations and impairment of social functioning.

       Cognitive Behavioral Therapy is the main intervention method for Social anxiety disorder. The cognitive restructuring in this therapy is the main effective mechanism, which relieves symptoms by changing the maladaptive schema of social anxiety sufferers. This study focuses on social anxiety sufferers who have symptoms but do not meet the clinical diagnostic criteria. The study plans to introduce Sandplay Therapy into the main intervention method for social anxiety and complete the most important cognitive restructuring part in the original intervention method by leveraging the implicit schema expression advantage of Sandplay Therapy. This study uses a case study paradigm of Sandplay Therapy to intervene in a social anxiety sufferer. From November 2022 to February 2023, there were 13 consultations and 1 screening interview. The consultation process can be divided into four stages according to the client’s changes: beginning stage (1–2), problem exploration stage (3–6), self-disclosure stage (7–9), and actual exposure stage (10–13). Before and after the intervention, the client’s social anxiety was evaluated using the Liebowitz Social Anxiety Scale (LSAS), Social Distress and Avoidance Scale (SADS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI), and the effectiveness of the intervention was analyzed based on their subjective reports.

       After the intervention was completed, all scores of clients’ scales decreased. Among them, the score of LSAS decreased from 57 points to 35 points, the score of SADS decreased from 18 points to 13 points, BDI decreased from 5 points to 4 points, and BAI decreased from 9 points to 7 points. Clients’ subjective reports reflected that their schema related to social anxiety had positive changes, and their fear of specific social situations had been significantly relieved. The intervention effect was more obvious.

       Looking back at the research process and analyzing the results, we can explain the effective mechanism of the intervention method used as follows: (1) The cognitive restructuring combined with Sandplay Therapy and Cognitive Behavioral Therapy changed clients’ schemas about themselves, social interactions, and life meaning; (2) Changes in self-schema can indirectly but effectively change clients’ social performance; (3) Using Cognitive Behavioral Therapy to conceptualize clients’ symptoms can effectively determine the target of cognitive restructuring; (4) Sandplay Therapy helps clients become aware of and change their self-schema.

       The conclusion of this study is that Sandplay Therapy can be combined with Cognitive Behavioral Therapy to achieve cognitive restructuring for social anxiety sufferers, effectively alleviate their social anxiety symptoms, and help clients become aware of and change their self-schema.