How to use Exposure Therapy for Overcoming Social Anxiety

social anxiety


Exposure therapy is one of the most common therapies used today. It is a treatment for many different anxieties and phobias. In this post I will discuss how to use exposure therapy for overcoming social anxiety.


What is exposure therapy?

The main goal of exposure therapy is to expose ourselves to situations that elicit anxiety. And by exposing ourselves to these situations in a gradual and systematic way, we can slowly habituate to environments that once caused us great fear and panic.

Usually, the individual first comes up with a “hierarchy of behaviors/situations” that cause them to feel anxious. For example, someone who is trying to overcome social anxiety may have a hierarchy like:

  • Going out in public (Low Anxiety)
  • Making eye contact (Low-Medium Anxiety)
  • Saying “Hi” to a stranger (Low-Medium Anxiety)
  • Having a short conversations with a stranger (Medium Anxiety)
  • Being interviewed for a job (Medium-High Anxiety)
  • Talking to a boss (High Anxiety)
  • Approaching a good-looking guy/girl at a bar (High Anxiety)
  • Going on a first date (Very High Anxiety)
  • Giving a public speech (Very High Anxiety)

Everyone’s hierarchy of behaviors/situations is going to be different depending on the individual and the type of anxiety. Therefore, it’s very important that you take the time to systematically break down your anxiety in a way that works best for you.

For example, if you start by exposing yourself to situations that elicit high levels of anxiety (like a public speech), then you’re probably just going to get frustrated and give up.

Therefore, it’s crucial that you start with situations that elicit low levels of anxiety first, then – once you overcome those – you can gradually move on to more difficult ones.

By doing this in a step-by-step way, you slowly condition yourself to these new situations and behaviors. They begin to become more familiar – you may even realize they weren’t “as bad” as you first thought they were. Your social anxiety diminishes more and more, and one day you look back and forget what it was ever like to be the “old, anxious you.”


What’s the “right exposure?”

It’s very important that you get the “right kind” of exposure. Because if you go into these situations without a clear goal in mind, then often you end up just making your social anxiety worse.

“Exposing yourself” to a situation doesn’t just mean walking in a room and standing their idly. You have to ask yourself, “How do I want to act in this situation?” Because if you expose yourself to new situations, but keep acting in the same old ways, then you’re just re-conditioning yourself to continue being anxious. You’re sort of exposing yourself to the situation, but you’re also partially avoiding it. Thus, you’re not really exposing yourself to your anxiety head-on.

For example, if you walk into a bar with the intention to meet new people, but you don’t actually approach anyone, then you’re just re-conditioning yourself to go into a bar, stand by yourself, and be really nervous.

If that’s your strategy, then it won’t matter how many bars you expose yourself to – you’ll still always be partially avoiding what you really want. Deep-down you may think you are trying something new, but you’re actually avoiding your social anxiety, which is the opposite of exposure therapy.


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Face-to-Face with Your Fear and Anxiety

anxiety


“Courage is not the lack of fear. It is acting in spite of it.”

Mark Twain


In many ways we may try to get rid of our fears and phobias by taking medication (or alcohol and drugs), going to psychotherapy, reciting affirmations, listening to hypnosis tapes, or by simply avoiding environments where we feel too much anxiety and worry.

But the truth is that experiencing some fear and anxiety is unavoidable, and it’s actually a good sign of a healthy mind. Often times, by acknowledging our fears (not avoiding them or suppressing them) we gain insight into areas in our life that we may need to improve upon.


Fear as a compass

When your hand touches a hot stove, it feels pain, and that pain motivates you to move your hand away. In the same way, fear is an important signal and motivator that can help guide our behavior.

Fear is like a compass that points you towards the life you want. All of your deepest desires are fear-ridden, from approaching someone youʼre attracted to, to starting a new business, to conquering your social anxieties. Whenever you feel fear, you know that you are going after what you truly want and growing as a person.

The truth is that whenever you try to make a significant change in your life, that change will usually be met with some kind of resistance or fear.This is because making changes requires that you start engaging in new and unfamiliar behaviors. And when engaging in these new behaviors, there will always be a degree of uncertainty – you’ve never acted in this way before, so you aren’t sure exactly what the rewards or consequences will be. This uncertainty can be a huge contributor to our fear, anxiety, and worry. But we have to learn how to embrace it anyway.

Confronting your fears face-to-face is the only way to truly overcome them. Avoiding fearful situations only exacerbates the problem. But when you begin to see fear as a sign of growth and boundary-pushing – when you are willing to step outside of your “comfort zone” – then you give yourself an opportunity to actually learn more about yourself and improve your life in the face of those fears.

You can’t get rid of these fears completely – you just have to find ways to embrace them in positive ways.


DIWA: Do It While Afraid

Fear doesn’t go away by learning about it. You need to actively seek new experiences and gain confidence in facing these physical and psychological obstacles. Only by exposing yourself to these new experiences do you begin to rewire your brain and habituate to these new environments and situations.

Sean Cooper has a mantra that helps him overcome fear: “acknowledge feelings and take appropriate action.”

There is no sense in suppressing or ignoring these feelings when they really exist. In fact, often the more we ignore or suppress our feelings, the bigger the feeling builds up inside of us. I like to sometimes think of our emotions as a baby throwing a temper tantrum. If you try to ignore the baby, it will only get louder and louder until it gets your attention. Our emotions work the same way – they are calling to us to get our attention.

Therefore, it’s crucial to acknowledge and accept our feelings. And while doing this, we can often become more aware of what causes our emotions, what they are trying to tell us, and how we should act in response to these feelings.


New actions can lead to new feelings

It’s important to remember that even though our fears and anxieties feel like they inhibit us from acting in ways we want to, our feelings don’t actually dictate the way we behave. In fact, by feeling fear and anxiety, but actings ways we want to despite these feelings, we can actually end up feeling better about ourselves in the end. By adopting new habits, we also adopt a new self-perception.

For example, some research has demonstrated that introverts who initiate social interactions (even when it makes them feel uncomfortable or awkward) later report feeling better about themselves. They often end up more proud of themselves, because they know they tested their limits and in return learned something new. This indicates that sometimes doing something outside of our normal code of behavior – while it can be a temporary source of pain – can also lead to long-term positive feelings like confidence and self-esteem.

The paradox is that we can’t experience this new sense of ourselves until we first face that fear or anxiety. In other words: it isn’t until we expose ourselves to these fearful activities that we truly find out they “weren’t as bad” as we first thought.


Facing fear in small daily doses

If you find yourself trying to face your fears and feeling utterly crippled by them, then you are probably starting off too big. For example, if you have social anxiety, then it’s probably not a good idea to start off by giving public speeches to hundreds of people or running for President.

You need to start with smaller activities, like maybe sparking a small conversation with a waiter or cashier. Or asking a really good-looking girl what time it is. Or maybe just making eye contact with everyone you walk passed on your way to work.

Where you start ultimately depends on what kind of fear and anxiety you have, and how strong it is. As a general principle: you should try to face your fears on a gradual basis. But you ultimately have to determine for yourself what are the appropriate steps to take – because everyone’s fears and anxieties are a bit different.


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Social Anxiety and the Amygdala

Social anxiety


A lot of our social anxiety is affected by an area in the brain called the amygdala.

Research shows that the amygdala plays a big role in our emotional reactivity, especially our “fight-or-flight” response when the brain senses danger. Studies have found that an overactive amygdala often correlates with higher social anxiety and social phobia. In theory, a more active amygdala triggers increased feelings of fear, worry, uneasiness, or dread.

Sometimes our amygdala can be conditioned to have such a strong emotional response to a stimulus that it overrides our logical thinking or reason. We may rationally understand that a fear has no basis in reality, but the amygdala’s reaction is so strong that we feel this fear anyway.

Neuroscientist Daniel Goleman coined this phenomenon amygdala hijack. Other researchers on emotion, like Joseph E. Ledoux, have further elaborated on this concept, describing it as when “emotional reactions and emotional responses can be formed without any conscious, cognitive participation… because the shortcut from thalamus to amygdyla completely bypasses the neocortex.”

The neocortex is usually associated with the conscious “thinking parts” of our brain, so when our fear response bypasses this region, then we often feel as though our emotions are emerging from a deeper part of our brains that lies outside of our conscious awareness.

Logical thinking is not enough to overcome social anxiety.

Many people may try overcoming their social anxiety solely by reasoning inside their heads and trying to adopt healthy beliefs (and these can certainly help!), but they are rarely enough to fully rewire our brains in order to experience less anxiety.

Thankfully, there are other methods we can use to help change the structure and reactivity of our amygdala. Here are some of those options:

  • Medication. There are several effective drugs currently on the market that have shown to have positive results in changing the structure of the amygdala. Selective serotonin reuptake inhibitor (SSRIs), like Citalopram (Celexa), Escitalopram (Lexapro, Cipralex), Fluoxetine (Prozac), Paroxetine (Paxil), and Sertraline (Zoloft), have all shown to be effective in the treatment of social phobia. See a psychiatrist and they will help you determine if medication is right for you.
  • Meditation. Daniel Goleman has theorized that meditation helps rewire connections between our amygdala and pre-frontal cortex. Our pre-frontal cortex is the part of the brain that causes us to stop and think about a situation; on the other hand, the amygdala is often seen as the opposite of this: it is more impulsive and it’s activity is more subconscious. However, by rewiring the connections between these two brain structures it is possible for us to exercise more conscious control over our emotional reactions. By engaging in weekly meditation, an individual can often develop stronger feelings of relaxation and equanimity, these are great combatants toward social anxiety.
  • Exposure Therapy. Exposure therapy is an important part of Cognitive-Behavioral Therapy (CBT) that encourages individuals to gradually expose themselves more to social situations and thereby become more habituated to these kinds of environments. Often by engaging in more social situations we find that our previous fears and worries were actually unfounded. And when we give our amygdala new experiences to learn from (and rewire in response to), then our anxieties can often diminish overtime.
  • Minimize substance abuse. Abusing drugs and alcohol can often damage our amygdala to the point where we depend on these substances in order to lessen our anxiety and inhibitions. While alcohol can sometimes be a valuable social lubricant, we have to be careful not to train our brains to rely on these substances in order to function properly. Moderation is key here. Here is a useful resource to help overcome substance abuse disorders.
  • Cognitive Restructuring. Cognitive structuring (or “reframing”) is another important part of Cognitive-Behavioral Therapy that can help diminish social anxieties and phobias. While it doesn’t affect the amygdala directly, it does affect other structures connected to the amygdala including the prefrontal cortex (a part of our brain responsible for conscious thinking and decision-making) and the hippocampus (which is responsible for memory formation). The goal of cognitive restructuring is to change our perspective and beliefs which can often reduce “contextual fear” – fear caused by certain attitudes and beliefs about ourselves and the world we live in.

As you can probably tell by now, your social anxiety can be managed with a wide array of different treatments and techniques. I and many others have found through personal experience that sometimes the very best treatment is to mix-and-match several of the above techniques. Often one technique can help, but it isn’t enough to fully overcome our excessive anxiety all by itself. Instead, you should give multiple techniques a fair chance, and by doing that you will definitely increase your probably of improving your social anxiety in the long-term.


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An Extreme Fear of Disapproval

fear of disapproval


We often have an extreme fear of disapproval from others.

This can often be driven by our evolutionary history (in the past, we depended on social approval from members of our tribe in order to survive), as well as social conditioning at a young age (from our parents and schools).

Maslow’s “hierarchy of needs” defines love and belonging as one of the core needs of a healthy human being. Next to food, water, and shelter, our survival also depends on our ability to adapt to our social world and build positive relationships with others.

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The Most Common Causes of Anxiety

anxiety

In this article I identify 3 of the most common forms of anxiety (including social anxiety, performance anxiety, and choice anxiety), as well as 5 of the most common causes of anxiety (including genes, health, psychology, history, and environment).


Anxiety disorders affect between 13-18% of the general population, but the truth is we all experience different forms of anxiety throughout our lives. An anxious mental state is often defined by feelings of fear, worry, uneasiness, or dread. It is often future-oriented, meaning that our anxieties are directed toward possible threats or negative experiences that haven’t yet happened.

In the real world, most of us experience anxiety in varying degrees depending on the situation. It isn’t always a bad thing, as some anxiety can motivate us to re-plan or re-think a situation before acting. However, excessive anxiety can be crippling to a point where we can’t decide, we don’t take action, or we mess up when the event finally comes.

Different Forms of Anxiety.

Anxiety can come in many different forms depending on what it is that triggers our feelings of fear, worry, or dread. These three types of anxiety are often the most common types discussed in modern psychology research, but there are probably other types of anxiety that don’t fit so neatly in these categories (specific phobias, existential anxiety, death anxiety, etc.) Nevertheless, these are the types of anxiety I will be referring to in this post:

    Social Anxiety

    Social anxiety is a fear or worry about social situations. We may feel uncomfortable or avoid environments that involve large groups of people (like school, work, public speeches, high school reunions, etc.) or we may even feel uncomfortable or avoid certain kinds of 1-to-1 interactions (like job interviews, dating, interacting with a stranger for the first time, or meeting a celebrity).

    Most people feel some kind of anxiety in these situations but it varies greatly from person to person. Some people may feel more comfortable in groups, while others feel more comfortable during 1-to-1 interactions. Some people may feel more comfortable talking to familiar faces, while others feel more comfortable meeting someone for the first time. It really depends on the environment and the person.

    For more on social anxiety, and how to overcome it, check out Sean Cooper’s The Shyness and Social Anxiety System.

    Performance Anxiety

    Unlike social anxiety, performance anxiety is a fear or worry about performances, such as a student taking a final exam at school, or a musician performing on stage, or an athlete playing at a big sports game. We worry that we won’t do our best, or that we will mess up or lose, and that anxiety can actually inhibit us from performing to our maximum capacity (or even performing at all, for example due to too much “stage fright”).

    Instead of focusing on what we need to get done to succeed, we become more focused on all the ways things that may go wrong. This can sometimes become a self-fulfilling prophecy. Our thoughts make us more uncomfortable and ill prepared, and then those thoughts lead to actions that reinforce our previous conceptions.

    Choice Anxiety

    Choice anxiety is an anxiety rooted in uncertainty when making decisions. The truth is that none of us can act or make a decision with full knowledge of what the consequences will be; the universe is just too complex, and our minds aren’t capable of completely understanding it. Due to this, we often feel anxiety when making a big decision in our life, because we don’t know if we will make the best possible choice.

    Some common big decisions we need to make throughout our lives include: what college to go to, what career to pursue, who to date/marry, where to live, what kind of car to drive, etc.

    We make decisions everyday and we have to face the “opportunity costs” from choosing one option over another. Some research suggests that the more options we have to choose from, the more difficult it is to make a decision. They claim that having more options leads to a higher “opportunity cost” (theoretically: the more we have to choose from, the more we miss out on), and when this opportunity cost becomes too big we can often suffer from paralysis by analysis. Paralysis by analysis inhibits us from making ANY decision because we are so lost on what the right course of action is.

I’m sure that you’ve experienced these kinds of anxieties through your life to varying degrees. That’s good. A lot of our anxiety can be healthy and natural. However, when it starts interfering with how we want to live our lives, then it can become a problem that we need to deal with. The first step toward dealing with this problem is identifying some of the potential causes of our anxiety, then we can determine what are the best ways to treat it.


The Most Common Causes of Anxiety

There are a lot of factors that can contribute to our anxiety (and our mental health more generally). In this section, I am going to discuss some of the most common causes of anxiety, and also some potential treatment options for each one. However, it’s important to remember that because our anxiety can be due to such a wide array of different variables, it is often better to integrate several treatment options simultaneously.

    Genes

    Certain gene variants may be associated with greater levels of anxiety. We all have a different biological make-up, and sometimes individuals may experience increased levels of anxiety for no other reason but that it is embedded in their genetic code. These genes essentially cause chemical imbalances in the brain that leader to your anxiety.

    Treatment options: If your anxiety is driven by your biology it may be possible to get prescribed medication from a professional psychiatrist. Beware, however, that many of these medications can have negative side effects (you may go through several different medications before finding one that works best – a good psychiatrist will help you through this process). Also beware that if your anxiety is caused by other factors than medication will only serve as a quick fix, but it won’t solve the deeper issues in your life. You may need to supplement your medication with other treatments.

    Health

    Anxiety can also be caused due to physical inactivity and poor diet. When we don’t treat our bodies right then that can often have an effect on our mental states.

    If we don’t eat balanced meals and get all the nutrition we need, that often means our brains aren’t getting enough nutrition either. This inhibits our brains from functionally as efficiently as they could be, which could very well become a contributor to higher levels of anxiety.

    Physical activity is also crucial to both our physical and mental health. Running, playing sports, going to the gym, dancing, and anything that provides exercise is a great way to relieve stress and anxiety that may build up throughout the days or weeks. It’s important that we have a way to channel hormones (like adrenaline and cortisol) in positive and healthy ways, otherwise they manifest themselves as stress and anxiety.

    Treatment options: If you don’t already take good care of your body, you’d probably be surprised of just how much less stressed and anxious you’d be if you started taking better care of your health. Try doing little things like replacing soda with water, eating less cake, going for a jog several times a week, or being more mindful of what you eat, and you’ll begin to feel better both physically and mentally.

    Psychology (our thoughts and beliefs)

    Many psychologists believe that our thoughts and beliefs are some of the biggest contributors to our mood and anxiety. When we look at our lives from a certain perspective or worldview, we may become more anxious than if we reframed our perspective to something different and more productive. One simple example: If you go into a date or a job interview believing that “I’m not good enough,” then you set yourself up to have an anxiety-driven experience. However, if you reframed your perspective, and instead you saw yourself coming from a place of strength or value, then you would probably be less likely to be as anxious.

    Treatment options: It’s important to be mindful of the thoughts and beliefs that drive our mood and behavior. If we discover that our thoughts inhibit us from acting appropriately, then it may be appropriate to adjust those beliefs or replace them with something new. For more on this approach you can check out “Social Anxiety and CBT.”

    For more on how to use psychology and Cognitive-Behavioral Therapy to overcome anxiety, check out Sean Cooper’s The Shyness and Social Anxiety System.

    History

    Our personal history and past experiences can also lead to more anxiety in the future. If we have a poor track record of job interviews or dates, then we may think we are inherently incapable of succeeding in these domains of life.

    Early psychologists theorized that our self-esteem could be calculated by taking our successes and subtracting them with our failures. The more we succeed, the greater our self-esteem. While this theory definitely doesn’t depict the full picture of self-esteem, it does provide insight into one factor that can influence our self-perception.

    Treatment options: It’s important to not let past failures dictate our self-esteem or anxiety about a situation, but when we start accumulating successes it can often become easier to keep ourselves motivated to overcome obstacles in the future. Keep this in mind, reflect on success for inspiration, and you can begin to turn your history around.

    Environment

    It is also likely that our anxiety is caused by a novel or unfamiliar environment. Anxiety can often be a rational response to an unknown environment because we never quite know what will happen or what risks or at stake. Our anxiety therefore signals to us that we are in danger, and often times this can rightfully inhibit us from taking part in behavior that we may sense as too risky.

    Of course, there are also some environments that we may fear irrationally. We may understand that it is a lot safer to take a plane than drive a car, but our anxiety remains persistent despite understanding the risks at stake.

    Treatment options: One way to treat these irrational anxieties is through something known as exposure therapy. Basically, we gradually expose ourselves to these environments until we become more and more comfortable with them. This kind of therapy largely makes up the “behavioral” component in Cognitive-Behavioral Therapy. I also elaborate on this more in “Social Anxiety and CBT.”

These are some of the most common causes of anxiety that I know of, although I’m sure there may be other causes that don’t necessarily fit in any of these categories. As you can also probably tell by now, there is a good chance that your anxiety is a combination of one or more of these factors. What makes you “you” – and what determines your thoughts and mood – is a very complex and interconnected process. But hopefully by reading through some of these causes you now have a greater understanding of what may be the driving forces behind your anxiety.


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