How do exposures help with social anxiety?
Some individuals experience high levels of anxiety that cause considerable distress and interference in social situations. While social anxiety is one of the most prevalent anxiety disorders among children and adults,1 the good news is that effective treatments exist.2
When it comes to cognitive behavioral therapy (CBT) for social anxiety, treatments typically include cognitive and behavioral components. In these treatments, initial therapy sessions might start with cognitive work of identifying unhelpful thoughts experienced in social settings. These will be thoughts like “he will think I’m stupid if he hears what I have to say,” or “she will see that I’m nervous and think I’m weird.” You then learn to challenge these thoughts through cognitive restructuring, a process of evaluating unhelpful thoughts and modifying them with a more balanced perspective.
While beneficial, cognitive work alone may not allow one to overcome social anxiety. That’s where behavioral interventions come into play, namely in the form of exposure to feared situations.
Exposures in social anxiety treatment
Exposure work can be quite challenging. After all, it entails facing what is anxiety provoking rather than avoiding it. It will likely make you anxious and uncomfortable and that doesn’t sound pleasant. So why would social anxiety treatments emphasize exposure? Before we try to answer that question, let’s consider the hypothetical case of “Amy.”
Amy is a working adult woman who has some social anxiety. She experiences anxiety in several different social scenarios, including when interacting with acquaintances or strangers. This is quite problematic because Amy’s new job requires her to network and attend social events on behalf of the workplace. She hardly knows anyone in the field. She feels better equipped to deal with circumstances where other people drive the conversation or when people approach her. When Amy’s social anxiety gets activated, her default behavior is to avoid, canceling work meetings with new clients by calling in sick. In some other instances, she might make excuses to avoid interacting with new people and have colleagues take over. Amy understands that how she is managing her anxiety is problematic and realizes that something needs to change. She also senses that improving her social anxiety at work may open doors and help her make better personal connections.
So how might Amy benefit from exposure work to overcome her social anxiety? Here are some of the ways:
1. Exposure can break the avoidance cycle.
Where there is social anxiety, there is often avoidance. And if not avoidance, there are usually urges to avoid or great amounts of distress coping and navigating that circumstance. For someone like Amy, there might be overt avoidance by canceling meetings with new clients. Should she be placed in a situation where she cannot avoid (e.g., her boss insists that she attend the next networking event or she might be in trouble), she will likely experience great distress and urges to leave.
When you avoid, you likely experience immediate relief, which means that you start to associate relief and avoidance. This creates a reinforcing cycle. After all, which would you rather experience, anxiety or relief? A reinforced behavior is one that is difficult to break out of and this means that we may end up seeking relief again in the future.
This leaves us stuck in the avoidance cycle rather than learning new ways to deal with the situation. Meanwhile, exposure helps create change. By entering and staying in the feared social scenario, you give yourself a chance to experience something differently.
While you may not be able to stop the avoidance cycle immediately, over time you will hopefully be able to engage in more social situations. Rather than avoiding 10 out of 10 social events, Amy’s avoidance might decrease to 8 out of 10 times, then 6, and so forth. She will likely develop more effective ways to navigate social interactions with exposures.
2. Exposure can lead to decreases in anxiety intensity.
Engaging in exposures might lead to an initial increase in anxiety. That is to be expected. Repeatedly practicing exposures is part of what contributes to overall decreases in anxiety. Let’s say Amy decided to attend a social event as part of a social anxiety exposure. As she talks to strangers, her anxiety might increase, but at some point it will peak and level off, then start to decrease. Her anxiety might experience periodic spikes during this process, which is normal. However, the anxiety intensity will likely decrease as she continues to stay in the situation.
3. Exposure allows for new learning to occur.
Anxiety is uncomfortable and is typically associated with urges to avoid. When we give in to these urges to avoid, we prevent learning from occurring. When Amy repeatedly engages socially with others during her exposure (e.g., approaching people at a social where she does not know anyone), she might start to learn new things, like “oh, I just stumbled over my words but no one seems to care” or “I expressed my opinion and they actually seemed interested in what I had to say.” If Amy were to continue to avoid, would she have these moments of learning? Exposure contributes to experiential learning, which can be a powerful force for change. You might learn that what you are anxious about does not happen, is likely not to happen, or even if it does happen, you are capable of managing that moment.
4. Exposure might increase your self-confidence.
Do you enjoy experiences of accomplishing or achieving something? Many people do, whether it be fixing a broken toilet, creating a website, or overcoming something that used to make you feel anxious. Should Amy persist with exposures with therapist guidance, she will increasingly be able to navigate social interactions. This will make her feel more confident and gain a greater sense of self-efficacy.
Maybe I need to work on my social skills, not on exposures?
The topic of social skills often comes up in social anxiety treatment. It’s common for individuals with social anxiety to question if they might benefit more from social skills training than exposure. While there are benefits to social skills training, there is not much research evidence to suggest that individuals with social anxiety are consistently deficient in their social skills.3
The current literature indicates that individuals with social anxiety tend to perceive that their social skills are less than adequate to accomplish their social goals. Coupled with evidence that shows that individuals with social anxiety tend to appraise their social interactions more critically than individuals without social anxiety, it seems likely that concerns for social skills might be due more to critical perception and appraisal rather than an actual deficit in these skills.
While social skills can certainly contribute to decreases in social anxiety, some researchers surmise that this is due to the inherent exposure that occurs as a person practices these techniques.
Final thoughts
We hope the reasons for engaging in exposures not only made sense but also created a reason for you to seek out therapy focused on exposures. At DC CBT, we offer social anxiety groups such as the Building Social Confidence group, and address social anxiety in individual therapy as well.
Please keep in mind that the benefits of exposures discussed in this blog post were written in the context of therapy (i.e. individual therapy, group therapy) where a CBT-trained therapist guides you through the process. A CBT therapist can also identify potential pitfalls, provide you with relevant education on the process of exposures, and problem-solve when exposures are not quite working as intended. There are many more nuanced matters that are not described in this post.
There will always be arguments for not engaging in exposures, but from a CBT perspective, exposures can be very effective if done properly, given time, and with the guidance of a trained therapist. If you’re used to giving into anxious avoidance and are considering trying something different, feel free to reach out to us. Whether it be through individual therapy or through the Building Social Confidence group, we will support and guide you through the process of starting to overcome your social anxiety.
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1. Heimberg, R. G., Stein, M. B., Hiripi, E., & Kessler, R. C. (2000). Trends in the prevalence of social phobia in the United States: A synthetic cohort analysis of changes over four decades. European Psychiatry, 15(1), 29-37. https://psycnet.apa.org/doi/10.1016/S0924-9338(00)00213-3
2. Rodebaugh, T. L., Holoway, R. M., & Heimberg, R. G. (2004). The treatment of social anxiety disorder. Clinical Psychology Review, 24(7), 883-908. doi:10.1016/j.cpr.2004.07.007
3. Stravynski, A., & Amado, D. (2001). Social phobia as a deficit in social skills. In S. G. Hofmann & P. M. DiBartolo (Eds.), From social anxiety to social phobia: Multiple perspectives (pp. 107-129). Allyn & Bacon.