How Does Exposure Therapy Help Social Anxiety?

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Reader’s Question

I have social anxiety and I want to use exposure therapy, but I am confused. Is my goal to get used to the pain in social situations, or to associate social situations with pleasure? If it is the former, I take it I could give myself as big a challenge as I can muster — I could humiliate myself publicly, with the right coping techniques. If it is the latter, I take it I must take very small steps. Painfully small steps, in fact. Am I supposed to keep pushing myself into social situations I can handle that will boost my self-esteem; or am I supposed to get used to the pain of failing a social situation, thus attempting to ‘nullify’ the need for self-esteem?

Psychologist’s Reply

Exposure therapy is when someone directly confronts that which they fear. For example, people who are afraid of heights are taken to high rise buildings, people who are scared of spiders remain in the same room with them and people with social anxiety — the fear of being in social situations — are encouraged to partake in group activities. Research studies have provided empirical evidence that exposure therapy works. However, it is a difficult process, so I congratulate you on being willing to work through it.

In order to understand why exposure works, you must first understand what happens with social anxiety. At some point in your life, you experienced social situations as anxiety provoking. You may have developed thoughts about them that heightened your beliefs about the ways in which they could harm you. For example, many people with social anxiety believe that others will not like them, that they will not be able to engage in conversation and make fools of themselves, or that the whole encounter will feel incredibly bad. As a result of these thoughts and feelings, social situations are avoided, thereby temporarily lowering the anxiety and preventing harm. However, the longer people avoid social situations, the more ingrained that coping mechanism becomes, while nothing is solved. In short, the problem gets worse. Thus, part of the goal of exposure therapy is to break the behavioral cycle.

Another goal of exposure is to demonstrate that the pain of the feared situation will not be as bad as you think it will. The more social situations you attend, the more comfortable you will become as your fears are not realized or, if they are, when you realize that you can survive them (with the help of appropriate coping techniques). So while you are correct in that part of the goal is enduring the pain, it is not necessarily about “failing” the situation but more about showing you that the pain will lessen and maybe even go away entirely.

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While most of the goals of exposure therapy involve confrontation of the feared situation, and pain endurance and reduction, in the case of social anxiety, there is also the hope that it will lead to an association of pleasure with what was once feared. It is hoped that by changing your thoughts about social situations, you will find ways to enjoy them. But that may never be the case. Some people never truly like group situations and instead only endure them. However, I am a strong proponent of finding something that will make you feel good, even for just a brief amount of time. Once you can do that, then you can enlarge upon that feeling, so that what was once dreaded becomes something that, if not pleasant, is at least tolerated.

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