Exposure Therapy for Social Anxiety

It's normal to want to avoid social situations that cause you anxiety because anxiety doesn’t feel good! However, when engaging in exposure therapy the rule is that short-term pain will lead to long-term gain! By learning to face the situations you have been avoiding you can discover first hand whether or not your feared expectations are likely to occur, and, how well you can cope. It can also be a great confidence builder as you repeatedly face situations and find out that...

  • People don’t point and laugh
  • You can present to a small group and sound knowledgeable
  • Everyone makes mistakes, but no-one cares
  • Friend’s don’t notice, or care, that you blushed (sweat, shook, etc.)
  • People enjoy your company
  • Etc!

Step 1:  Get to know your social anxiety better

To face your fears, it is helpful to know what your specific fears are about social or performance based situations. For example, are you afraid of saying “hi” to a co-worker or asking a stranger for directions? Perhaps you dislike making phone calls or avoid going out for happy hour with co-workers. Refer back to the list you made when you spent some time observing your social anxiety and identifying the situations that cause you anxiety. Common types of feared social situations include public speaking, informal socializing (small talk), being assertive, dealing with conflict, being the center of attention, eating and drinking in front of others, speaking to authority figures, and interacting with unfamiliar people.

Step 2: Build a fear ladder

Once you understand what makes you socially anxious, you are ready to develop a fear ladder. A fear ladder is an ordered list, or hierarchy, of your triggers beginning with the least scary to the most scary. For example, if you have performance fears, saying “good morning” to your boss may be a situation that is low on the fear ladder because it only evokes a fear of 1/10. But asking your boss for a raise may be a situation that is very high on the ladder because it evokes a 9/10 fear. See Examples of Fear Ladders for some ideas about building your fear ladder.

TIP: Build a separate ladder for each area of your social fear if you have more than one area. For example, you may need a separate ladder, or hierarchy, for all situations related to your fear of making mistakes. You may also need a separate ladder for all situations related to your fear of attending social events.

Step 3: Climb the fear ladder

Once you have built a fear ladder, you are ready to face your fears by putting yourself in situations that cause you anxiety. Starting with the least scary situation, repeat that activity or enter that social situation (for example, saying “hi” to a co-worker every morning) until you start to feel less anxious doing it. Once you can enter that situation without experiencing much anxiety (on numerous occasions), move on to the next situation on the list. For more information, see Facing Your Fears – Exposure.

KEY POINTS TO MANAGING YOUR SOCIAL ANXIETY (see Facing your Fears: Exposure for more tips):

  • Bottom up. Start with the easiest item on the fear ladder first (i.e. fear=2/10) and work your way up.
  • Track progress. Track your anxiety level throughout the exposure exercise in order to see the gradual decline in your fear of a particular situation. Use the Facing Fears Form to help you do this.
  • Feeling anxious when you try these exercises is a sign that you are on the right track. If you’re not anxious you might be too low on your ladder, and if you are feeling flooded with excessive anxiety, chances are you started too high up on the ladder. Remember that regardless of how intense your fear is, it will peak and then level off. What goes up must come down! Even if you do nothing about it the fear will eventually go away on its own.
  • Don’t avoid. During exposure, try not to engage in subtle avoidance (e.g. thinking about other things, drinking water, staying near an exit, etc.). Avoidance actually makes it harder to get over your fears in the long term.
  • Don’t rush. It is important to try to stay in the situation until your fear drops by at least half (e.g. from 6/10 to 3/10), or until you notice a significant reduction from your fear at the start (e.g. from 7/10 to 4/10). Also, focus on overcoming one fear item at a time. It is a good idea to do the exposure repeatedly until the first item on the hierarchy no longer causes much of a problem for you.
  • Stick with it! Do the exposure exercises as often as you can. You are trying to build up positive experiences to replace previous ones where you felt defeated by your social anxiety. Too long a gap between exercises makes this more difficult.
  • Recruit help! Enlist the help of family and friends. It can help to find someone to work with who can talk to you calmly and positively while you are doing the steps. Make sure the helper you recruit is not over-sympathizing or endlessly asking how bad you are feeling. This will make it harder for you to focus on the steps and to stay positive.

Meeting New People

Once you have gained some confidence in facing social situations, it may be time to start thinking about expanding your social network. For some individuals with social anxiety their anxiety may have prevented them from engaging in routine life situations or gaining experiences like their same-aged peers. Now that they are gaining confidence and feeling less anxious, they may want to start to do things they previously avoided. Once such area is developing new relationships. Having opportunities to meet other people and develop friendships is very important. Social situations that provide opportunities for repeated contact are the best ways to develop friendships. Try and brainstorm ways to get involved with other people. Here are some ideas of where you can meet people:

  • Work or school (talk to co-workers, go for lunch together, share coffee breaks)
  • Play a sport/exercise (join a gym or running group, play soccer or tennis)
  • Join a club/organization (travel club, hiking group, singles group, etc.)
  • Take a class (painting, pottery, language course (e.g., Spanish, French) etc.)
  • Volunteer (community centres, hospitals, charitable organizations)
  • Take group lessons (swimming, dance)
  • Go to sports facilities (skate park, ski hill)
  • Dating services/on-line dating

TIP: Make a concrete plan to meet new people. Pick from some of the ideas listed above and take the steps to get involved. For example, do a search on the internet for hiking groups in your area. If you make an attempt to make new friends and it doesn't work out, keep trying. It takes time to develop friendships and relationships. It can be very scary at first but if you don’t try, you reduce your chances of making friends or meeting someone special. See Guide to Goal Setting for some ideas on how to set goals around meeting new people.

What if I Need Other Skills?

Many people with social anxiety disorder believe that they lack social skills. In many cases, these people have the skills but lack the confidence to use them. However, some people do have deficits in their social skills and may benefit from learning strategies for communicating more effectively. For more information, see Effective Communication – Improving Your Social Skills.