Exposure for Social Anxiety

Exposure therapy is an evidence-based intervention whereby a person chooses to expose themselves to a feared emotion, situation, or mental imagery to create new associations and decrease reactivity and distress. Exposure therapy is effective for reducing suffering that is generated through repeatedly avoiding situations that are perceived to be dangerous, but do not result in bodily harm. In a previous blog post on exposure therapy, Courageously Facing Fears Increases Positive Emotions, I demonstrated that exposure therapy is actually an empowering process that brings out courage when the therapist is trained in the evidence-based principles of exposure. In this blog post, a more in-depth understanding of exposure for social anxiety will be provided by offering specific examples of exposure exercises that are effective.

When working on exposure therapy for anxiety, it is important to identify the specific type of fear that is triggering the anxious reaction. For example, one common social fear that people experience is the fear of disappointing other people. Individuals may fear that by disappointing others, the other individual will react angrily, resulting in an intense emotional experience that is difficult to handle. After isolating the specific fear (e.g., fear of disappointment), the therapist can then work with the client to generate specific constructed situations that would induce the fear of disappointment. These situations could range from failing to text back a friend, asking a lot of questions in a grocery store, or ordering food at a restaurant. After generating specific situations, effective exposure exercises do not typically involve merely completing more of these activities. People can complete feared tasks many times and still maintain anxiety toward the particular task. Instead, the therapist and client then generate specific anxiety-inducing situations whereby the actions taken are completely inside the person’s control. Generating these activities is a process that involves creativity.

making check listsSending a text message to another person is inside one’s control, but receiving a text message back from another person is not inside one’s control. Asking a lot of questions in a grocery store is inside one’s control, but the answers that are given to those questions are outside of one’s control. Likewise, asking for food at a restaurant is inside one’s control, but getting an appropriate response is outside of one’s control. The exposure exercise only encompasses the part of the exercise that the person can complete and check off of a list. The other person’s response to the exposure exercise is irrelevant to decreasing anxiety and breaking the anxious pattern. Therefore, an exposure exercise, for someone who fears asking long questions to store managers, might involve calling a store and asking a long question, and then hanging up before listening to the answer. This exposure would be repeated several times, in a controlled way, with a particular amount of time, until the person feels increased confidence about completing the activity. 

One additional tip for complex forms of anxiety is that exposure exercises can involve watching videos that prompt the same emotions as the event when it is difficult to generate an in vivo exposure. For example, if someone is anxious about other individuals’ behaviors when they are angry (e.g., when other people yell or throw things), this fear can be reduced by watching videos of people who are angry. During the exposures, the person is asked to be mindful of the video for a certain period of time. After the video, the therapist helps the client to practice paced breathing. This process then repeats several times to decrease the intensity of the emotional reaction over time. 

getting coffee, checking the timeAll in all, implementing exposure therapy for social anxiety is a process that involves an understanding of the principles of exposure, and creativity when generating possible exposure scenarios. Moreover, the exposure must be something that a person can do, rather than a random, uncertain response of another individual. If you are suffering from anxiety, work with a therapist to implement effective exposure techniques that are tailored to your particular difficulties, and you will likely experience the benefits of courageously facing your fears. 

About the Author

Samuel Eshleman Latimer (he/his), Psy.D., is a clinical psychology postdoctoral fellow that specializes in effective conflict management and dialectical behavior therapy. Samuel also works to help individuals, couples, and families decrease interpersonal difficulties and manage challenges associated with borderline personality disorder. Samuel believes that people do not need to choose between learning effective techniques that are based on science and developing warm, genuine relationships, as both of these styles complement each other. Click Here to learn more about Samuel’s experience and therapeutic style.