EXAMPLE EXPOSURES

 

These are exposures that I have frequently recommended to my patients during the course of treatment.

"One Extra Sentence" Exposures

As it sounds, this exposure is about pushing yourself to talk to people just a little bit more than you normally would. You say one “extra” sentence to cashiers, waiters, customer service reps, coworkers, acquaintances, in meeting etc. For example, you might ask someone how their day is going, if they heard about a recent news event, or what they did over the weekend. This will help you get you in the habit of interacting with people (rather than just sticking to the facts/business).

Silence Exposures

While it may sound counterintuitive, most people with social anxiety are much more afraid of being quiet than they are of speaking. I distinctly remember an intense fear of being silent around my friends and having nothing to say. Anything more than about a 5 second pause in the conversation would trigger me to feel self-conscious. As a result, I found it impossible to relax even around my closest friends, and would become drained and feel overloaded when I was around them for too long. Silence Exposures helped me overcome this. Around close friends, romantic partners, or family members, I would purposely read a book, surf the internet, watch TV, or visually scan the environment while remaining silent for a few minutes. If my company started speaking, I would reciprocate, but I would try to get comfortable with not generating conversation myself for a few minutes. As a result of this exposure, I am now fairly comfortable relaxing around other people. I can also be around other people for much longer before feeling drained because periods of silence take much longer to trigger my anxiety.

Passive Social Anxiety Exposures

One of the most effective ways of decreasing passive social anxiety is by going to a location that will trigger mild passive social anxiety and doing a Sentence Exposure. I used to go to coffee shops, order a coffee, and pretend to read a magazine. Meanwhile, I would purposely repeat the sentence "everyone is looking at me" over and over again in my head. After anywhere from 10-20 minutes, I would typically look up and realize that no one was staring at me. I later did the same thing at baseball games and concerts. Whenever I randomly feel anxious in a crowd, I do a Sentence Exposure until I am back in the moment/feeling calm. Because exposures must be mild, it is best to start with a location that will only trigger mild anxiety (for example, a relatively empty park or coffee shop) before working your way up to a very crowded area.

Fashion Exposures

One example of a Fashion Exposure is to wear something different each day (alternating between 5-10 tops and 2-3 bottoms). These exposures have been helpful for patients who wear the same outfit every day and/or suffer from passive social anxiety. I have seen many patients who either always wear black or always wear a sweat-shirt and jeans. When I ask them to wear something different every day, they often feel self-conscious and “phony” the first few times they leave the house. But inevitably, after two to three weeks they enjoy wearing new clothes and different colors and they notice a lift in their mood.

Wearing shorts and short sleeves is another Fashion Exposure I frequently recommend to patients. I’ve had many patients who have avoided wearing shorts and short sleeves for years because it makes them feel self-conscious. Despite the initial anxiety, after 2-3 weeks, it almost always starts to feel normal to them.

For patients with passive social anxiety, I often recommend going to the trendy part of town (i.e. Melrose Ave in Los Angeles) and buying 3 shirts and 1 bottom. The first time I wore a “trendy” outfit, I remember thinking somebody would stop me and accuse me of being fake. But when I got compliments from my friends instead, I felt my self-confidence rise. Within 2-3 weeks of wearing fashionable clothing, I actually started to enjoy getting attention when I walked down the street. This was a big change for me.

"Expressing Emotions" Exposures

This exposure applies to opening up and being assertive (which are both important social skills). People with social anxiety are often very reluctant to express their emotions (i.e. “I feel happy, sad, anxiety, angry, frustrated, scared, excited” etc.). They feel more “exposed” and open to criticism when making such statements. However, expression of emotions is crucial for allowing others to feel close to you and for being assertive. Expressing at least one emotion a day (whether to a cashier, “This weather makes me happy” or an acquaintance, “I was excited to see that movie yesterday” or to a friend, “I was so angry about something my boss said”) can help you gradually overcome this anxiety and will make you feel much more free about expressing yourself.

Physical Contact/Touching Exposures

Many of my patients have felt uncomfortable with shaking hands, hugging, holding hands (with children or significant others), touching shoulders to get a person's attention, or putting their arm around the back of someone’s chair. Avoiding physical contact can cause problems because other people often initiate social touching, and this kind of touching allows others to feel closer to you. An assignment that was helpful for both me and my patients has been to try to “touch one person a day”. The touching is specifically platonic (i.e. it is not meant to include kissing, or touching legs and rear ends). I remember high-fiving and fist-bumping my friends, putting my arm around the chairs of people sitting next to me, and hugging my family members as huge steps forward in my physical comfort level.

 

Relationship Duration Exposures

My patients with commitment phobia/a fear of intimacy will often notice a pattern of ending relationships after a certain amount of time, whether it be one month, 3 months, 1 year or somewhere in between. I myself always seemed to break up with girlfriends at about the one year mark and after the 4th relationship in a row I began to fear that I would be alone forever. So, I decided that I would purposely date the next girl for more than a year as a “Relationship Duration Exposure”. When the year mark came around, sure enough, I felt a strong feeling that she was “wrong” for me and I should leave her right away. Instead of breaking up with her, I stayed with her and experimented with trying to alter her “annoying” behaviors by being assertive. I was shocked to find that she was willing to change in response to my feedback. She no longer asked for so much reassurance, she gave me more time to myself, and she teased me far less often around other people. Although the relationship still ended (I broke up with her after 1.5 years), I still felt as though I had both broken through the “1 year” mental barrier and had learned a valuable lesson in assertiveness and direct communication.

"Abstinence From Reassurance" Exposures

Many of my patients allay their social anxiety by asking for reassurance from their friends and loved ones. “Do you like me?” “Are we still friends?” “Are you having fun?” “Am I boring you?” “Are you mad at me?” “Do you love me” and finally "Am I asking you too many questions" are all examples seeking reassurance to decrease social anxiety. There are several problems with reassurance seeking: it makes you feel insecure (regardless of their answer), it irritates people upon repetition, and it loses its effectiveness quickly (i.e. you start to become “immune” to reassurance and no longer believe it as much). “Abstinence from Reassurance“ means refraining from asking for reassurance for an entire week at a time. I remember forcing myself not to ask my friends if they like me. It was hard to resist the impulse at first, but after a few weeks, the question itself stopped coming to mind and I was able to feel more relaxed in their company. I’ve had several patients report that by abstaining from asking if their boyfriend/girlfriend loved them for a week at a time, they got into less arguments and felt more secure in the relationship.

Role-Play Exposures

Before a speech or a difficult conversation (i.e. being assertive, making a presentation, asking for a raise, or asking someone on a date) it is often helpful to role-play the speech or conversation out-loud multiple times when you are alone. This exposure works best specifically when it is out-loud (rather than doing it silently in your head). The first few times I role-play a presentation, my voice usually cracks. After 3-4 repetitions, my voice is smoother but I still feel nervous. After about 10 repetitions, I feel calmer. If I really want to make sure I am completely calm, I repeat the role-play about 15-20 times (i.e. “Ad Nauseam” – until I am sick of it), then I know I am ready to do it in real life with less anxiety.

"Saying No” Exposures

Many of my patients with social anxiety have trouble saying “No” to people. As a result, they end up feeling overextended (i.e. doing too many favors) and feeling like their life is not their own. One of my favorite cures for this is a "Saying No" Exposure. I tell my patients that they must say “No” three times a week for 3 weeks in a row. Any “No” will count, whether it's saying no to a favor, to a work assignment, or to a friend’s first suggestion for a restaurant or movie. If nothing comes up that you want to say "No" to, then for the purpose of this exercise say "No" to some of the things that you would have wanted to say "Yes" to. Ideally, you should continue this exercise until saying “No” stops producing anxiety. You can then be sure that your decisions are based on your actual preferences (rather than anxiety).

“Assertive Statement” Exposures

As you’ll read in the social skills section of this website, my favorite technique of assertiveness is something called an "Assertive Statement” (i.e. “When you do X behavior, it makes me feel Y emotion”). I describe the technique in detail in the assertiveness section, but doing the technique is actually an exposure. Many people feel very anxious the first few times they are assertive. With repetition and practice, making an Assertive Statement becomes much easier and less anxiety-provoking.