How to Practice Exposure Therapy for Social Anxiety Disorder

Medically reviewed by Steven Gans, MD

Exposure therapy for social anxiety disorder (SAD) can help you overcome fears of specific social and performance situations. Although exposure training is normally conducted with the assistance of a therapist as part of a cognitive-behavioral treatment program, it can also be incorporated into your daily life.

If you have social anxiety, you most likely face these types of situations with fear and dread or avoid them completely. This strategy can sustain your anxiety in the long term.

Takeaway

While avoiding situations you fear might alleviate your distress in the short term, you are teaching yourself that you can't handle those triggers.

Leaving situations in a state of panic also teaches you they are to be feared. Ideally, you need to gradually introduce yourself to increasingly more difficult situations and stay in those situations until your fear subsides. This type of exposure training can be done in real life (in vivo) or in your imagination.

At a Glance

Exposure therapy can be a highly effective treatment for social anxiety and social fears. If you are trying to address symptoms of social anxiety, you can also use these strategies on your own to learn to face your fears. Keep reading to learn more about how to use exposure therapy to address different situations that may trigger symptoms of social anxiety disorder.

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Exposure for Eating Fears

People with social anxiety disorder (SAD) who are afraid to eat in public are generally fearful that they will embarrass themselves while eating.

Such fears may be triggered when a person faces eating in certain situations, with certain people, or in certain settings. Fears vary from person to person but may involve the fear that their hands will shake, they'll spill something, or that they might choke.

Exposure therapy for this fear involves gradually engaging in more difficult situations involving eating in front of others. For example, a person might start by imagining themselves eating in front of others and then gradually work their way up their fear hierarchy.

Related: Understanding the Fear of Eating in Front of Others

Exposure Therapy for Paruresis (aka "Shy Bladder")

One of the more difficult fears associated with social anxiety disorder is a phobia of using public restrooms. Paruresis (sometimes referred to as "shy bladder syndrome") is a phenomenon where people find it difficult or impossible to urinate when other people are around.  This fear can impact your ability to function and may lead to isolation and the desire not to leave home.

Paruresis is a type of specific phobia, which is a phobia related to a specific situation, object, or situation.

Takeaway

Estimates suggest that around 2.8% and 16.4% of all people experience this phobia, and around 5.1% to 22.2% of people with this phobia also have social anxiety disorder.

If you have this fear, it is possible to use the principles of exposure therapy to gradually become more comfortable using restrooms in public. You might imagine using a public restroom and then gradually work your way up to using a public facility. You might start in an uncrowded setting and progressively use restrooms in increasingly crowded settings.

Related: Specific Phobia DSM-5 Diagnostic Criteria

Exposure for Phone Phobia

Are you afraid to talk on the phone? Do you become particularly anxious when talking on the phone in front of other people? Do you sometimes avoid the phone or let the answering machine pick up?

If you answered yes to any of these questions, you might want to consider exposure therapy for phone phobia. The fear of talking on the phone is a common problem for many people, particularly those who have social anxiety disorder.

Takeaway

You can learn to face this common fear by using a hierarchy involving telephone scenarios.

You might start with simple situations that don't induce much anxiety before slowly working your way up to more challenging scenarios. As you gain more experience and confidence with making phone calls and talking on the phone, your anxiety will gradually lessen.

Related: What Is Phone Anxiety?

Exposure for the Fear of Social Situations

People with SAD commonly fear a range of social situations. Examples of social situations that can trigger symptoms of anxiety include:

• Meeting new people

• Going out on a date

• Having a job interview

• Speaking in class

• Talking to a cashier at the store

• Speaking in public

• Going to a party

• Entering an unfamiliar place

Exposure therapy for the fear of socializing can involve a hierarchy including these situations and any others that cause you anxiety.

Takeaway

This is one of the easier exposures to conduct because it is relatively straightforward to find and involve yourself in the situations that you fear.

Related: How Do I Get Over My Fear of Social Situations?

Exposure for the Fear of Being the Center of Attention

Often, those with SAD have a debilitating fear of being the center of attention. You might blush or shake when thrust into the spotlight or quickly try to deflect the conversation if the topic turns to you.

The problem is that constantly trying to avoid the limelight can increase fear and anxiety about these situations. This can have a severe impact on your life, limiting your ability to participate in activities and succeed in school and at work.

Takeaway

This can lead to missed opportunities, reduce your achievement, create additional anxiety, and contribute to social isolation.

Like other difficult situations, you can overcome your anxiety about being the center of attention by gradually facing the situations you fear. If you are doing exposure therapy on your own, start by creating a list of situations that trigger feelings of fear. Rank them according to the least to most fear-inducing. Then, slowly and safely work your way through each situation.

Related: Fear of Being the Center of Attention

Exposure for Public Speaking Fears

Fears of public speaking are common. It is one of the most common types of social fear. Research suggests that 15% to 30% of all people have public speaking anxiety.

However, when anxiety about speaking in front of others has a severe impact on your personal and professional life, it may be diagnosed as SAD. This fear can also be considered a type of specific phobia known as glossophobia.

Takeaway

Gradually facing increasingly difficult public speaking scenarios is one way to overcome your fears.

You might choose to start by giving a toast at a party and eventually work up to taking a course offered by Toastmasters.

Related: How to Manage Public Speaking Anxiety

Exposure for the Fear of Conflict with Others

The fear of conflict with others causes many with social anxiety disorder to keep silent about personal opinions and allow themselves to be taken advantage of by those around them.

Takeaway

Instead of shying away from conflict, exposure therapy will help you to gradually face potential conflict and learn that you can handle it when others disagree.

A key part of this exposure is also learning to be more assertive and practicing assertive behaviors. Strategies such as learning how to say no, avoiding people-pleasing, and being direct can help.

Related: Overcome the Fear of Conflict With Therapy

Takeaways

Self-administered exposure techniques can be helpful for social anxiety that is not so extreme that it renders you housebound or facing severe panic attacks in most social or performance situations. If you do find yourself with severe symptoms, exposure therapy practiced on your own may be too difficult.

In this case, it's best to work with a mental health professional who can guide you gradually through the situations that you fear, being sure to first work on the thought patterns that keep you stuck.

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Read the original article on Verywell Mind.