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ea0fef5311ab-0 | Changing Your Anxious Thoughts and Expectations
113Examples of Personalization In Reality
At a friend’s birthday party, I
was talking to another guest
and we ran out of things to
talk about very quickly. I think
the conversation ended so fast
because I am so boring and
can’t think of things to say.In reality, other factors that may have contrib -
uted to the situation include (1) the other person
couldn’t think of anything to talk about, (2) I had
nothing in common with the other guest, even
though neither of us is actually boring, and (3) it
is normal for many conversations at parties to end
fairly quickly. Nobody was at fault.
The fact that my boss got
angry at me for making a
mistake is proof that I am
incompetent.In reality, other factors that may have contrib -
uted to the situation include (1) my boss is always
getting angry at people, so I shouldn’t feel singled
out, (2) my boss’s expectations are too high (I
know that not every boss in the world would have
yelled at me for making a mistake; part of why my
boss became angry had to do with his own
expectations, rather than me making a mistake),
and (3) there are many reasons why people make
mistakes besides incompetence.
People were falling asleep
during my presentation,
proving once again that I am a
really boring speaker.In reality, other factors that may have contributed
to the situation include (1) the topic was somewhat
dry and would have been difficult for any speaker
to make exciting, (2) the presentation was late in | shyness_social.pdf |
ea0fef5311ab-1 | to make exciting, (2) the presentation was late in
the day, and the audience was feeling tired, and (3)
it is normal for some people to feel bored at a talk;
other people probably found it interesting.
I was in an elevator and a
woman was looking at me. She
was probably thinking that I
looked strange.In reality, other factors that may have contributed
to the situation include (1) she was staring at me
because she liked the way I look or what I was
wearing, (2) she was looking in my direction but
wasn’t really looking at me (maybe she was staring
into space or daydreaming), and (3) she noticed
me but was thinking of other things.
Can you think of recent examples of times when you engaged in personalization? If so,
list your own examples of personalization in the space below: | shyness_social.pdf |
e3e8274b8293-0 | The Shyness & Social Anxiety Workbook
114“Should” Statements
“Should” statements are incorrect or exaggerated assumptions about the way things ought
to be. Statements that include words like “always,” “never,” “should,” and “must” are
often “should” statements. Sometimes, the tendency to use words such as these is a sign
of having overly rigid and perfectionistic expectations for yourself or for others. Here
are some examples:
Examples of “Should” Statements
UÊI should never feel nervous around other people.
UÊI must never let my anxiety show.
UÊI should never make mistakes.
UÊI must never inconvenience other people.
UÊOthers should never think badly about me.
UÊI ought never to do anything to draw attention to myself.
UÊOthers must never tease me or laugh at something that I have done.
UÊI should always be interesting and entertaining to others.
UÊI must do things perfectly so everything is just right.
In the space below, list examples from your own life of unreasonable expectations
(“shoulds”) that you hold for yourself or others:
Catastrophic Thinking
Catastrophic thinking (also known as catastrophizing ) is the tendency to assume that if a
negative event were to occur, it would be absolutely terrible and unmanageable. From
time to time, we all make mistakes, offend others, or look foolish. One difference
between people who are socially anxious and those who are not particularly anxious is
how they deal with these unfortunate social events. People who have very little social
anxiety are often able to say to themselves, “Who cares what this person thinks? I have | shyness_social.pdf |
e3e8274b8293-1 | the right to make a mistake from time to time.” Or, “I feel sorry that I upset that person, | shyness_social.pdf |
a0a2f99c24c5-0 | Changing Your Anxious Thoughts and Expectations
115but everyone puts their foot in it at times.” In contrast, people who feel anxious around
others are more likely to think, “It would be a disaster to have others think badly of me.”
Below are more examples of catastrophic thinking:
Examples of Catastrophic Thinking
UÊIt would be terrible if my anxiety showed during my presentation.
UÊI would not be able to handle making a fool of myself.
UÊIt would be terrible to be unable to think of things to say during my date
on Saturday night.
UÊIf someone shows signs of not liking me, it feels like the end of the world.
UÊIt would be terrible to lose my train of thought during a presentation.
UÊIt would be a disaster if I blushed while answering a question in class.
In the space below, list examples of times when you have catastrophized or exaggerated
how bad a particular outcome would be if it actually were to occur:
All-or-Nothing Thinking
All-or-nothing thinking (also called black-and-white thinking ) is the tendency to judge any
performance that falls short of perfection as being completely unacceptable. People who
engage in this style of thinking tend to categorize their behavior as being either perfect
or awful, without acknowledging all of the possibilities that lie between these two
extremes. As with “should” statements, all-or-nothing thinking is associated with exces -
sive perfectionism and a tendency to hold unrealistic standards. Following are several
examples of all-or-nothing thinking:
Examples of All-or-Nothing Thinking
UÊIf I lose my train of thought even once, I will blow the entire presentation.
UÊEven one person thinking I look nervous is too many. | shyness_social.pdf |
a0a2f99c24c5-1 | UÊEven one person thinking I look nervous is too many.
UÊIf I don’t get an A on my exam, my teacher will think I am stupid. | shyness_social.pdf |
29ad9352a88e-0 | The Shyness & Social Anxiety Workbook
116UÊIt is unacceptable if my boss makes any negative comments or suggests even
one area for improvement during my annual performance review.
UÊShowing any signs of anxiety is almost as bad as falling completely apart.
In the space below, list examples of the times when you engaged in all-or-nothing
thinking:
Selective Attention and Memory
Selective attention is the tendency to pay more attention to certain types of information
than to other types. Selective memory is the tendency to remember certain types of informa -
tion more easily than other types. As discussed earlier, people are more likely to attend
to and remember information that is consistent with their beliefs. Therefore, people with
social anxiety are more likely than others to remember times when they were criticized
or teased by another person or when they performed poorly in a social situation. When
performing in social situations or interacting with others, individuals with social phobia
are more likely to notice people who appear to be bored or disapproving. Some other
examples of selective memory and attention are provided below:
Examples of Selective Attention and Memory
UÊIgnoring positive feedback from a teacher or boss (in other words, discount -
ing positive feedback as if it doesn’t matter), yet taking negative feedback
very seriously (for example, letting negative feedback ruin your day)
UÊFocusing on the one low grade on your report card and ignoring all the
high grades
UÊRemembering being teased in high school, while forgetting about the good
times spent with friends after school
UÊFocusing on audience members who seem bored during your presentation
and ignoring those in the crowd who appear to be enjoying your talk
UÊFocusing on the moment during a conversation when you stumbled over | shyness_social.pdf |
29ad9352a88e-1 | UÊFocusing on the moment during a conversation when you stumbled over
your words and lost your train of thought, while ignoring the fact that the
rest of the conversation was fairly smooth | shyness_social.pdf |
28f7336f676b-0 | Changing Your Anxious Thoughts and Expectations
117Can you think of ways in which you selectively pay attention to events or information
that confirm your anxious beliefs and selectively ignore information that is inconsistent
with those beliefs? In the space below, list examples of times when you have engaged in
selective attention or memory:
Negative Core Beliefs
In addition to paying attention to your negative thinking in particular situations that
trigger your anxiety, it may also be useful to become more aware of any deeper, more
central, and long-standing assumptions that contribute to your feelings of anxiety. These
assumptions are called core beliefs and they can include negative assumptions that people
hold about themselves (for example, “I am incompetent”), other people (for instance,
“Other people cannot be trusted”), and the world (such as, “The world is a dangerous
place”). The more strongly held these core beliefs are, the more difficult they may be
to change.
One technique for uncovering core beliefs involves continually asking about the
meaning of each fearful belief you have until the core beliefs underlying your anxious
interpretations are revealed. This process is illustrated in the following conversation
between Liam and his therapist:
Liam: I am terrified to ask my coworker Cindy out on a date.
Therapist: What are you afraid might happen if you ask her out?
Liam: Mostly, I’m afraid she will say no.
Therapist: Why would that be a problem?
Liam: If she rejects me, it will probably mean that she doesn’t find me attractive.
Therapist: What would be so bad about that?
Liam: It will confirm my own belief that I am unattractive. | shyness_social.pdf |
28f7336f676b-1 | Therapist : What if that’s true?
Liam: Well, if I really am unattractive, that means nobody will ever think I’m
attractive or want to date me. It would mean that I am unlovable.
Therapist: What would be bad about being unlovable? | shyness_social.pdf |
210b8cb98990-0 | The Shyness & Social Anxiety Workbook
118Liam: If I am unlovable, I am bound to be alone forever.
Therapist: So, to summarize, you seem to be saying that (1) if another person turns
down your invitation for a date, it means that she finds you unattractive, (2)
if another person finds you unattractive, then everyone will find you unat -
tractive, (3) being turned down for a date means that you are unlovable and
destined to be alone forever. Do you think of yourself as unlovable?
Liam: I think I do. Part of me knows it isn’t true, but much of the time I just can’t
shake that belief.
HOW TO IDENTIFY YOUR ANXIOUS THOUGHTS
AND PREDICTIONS
In chapter 3, we discussed strategies for identifying your anxious thoughts. We suggest
that you review the relevant passages in chapter 3 on identifying anxious thoughts before
trying to use the techniques discussed in the remainder of this chapter. There is no point
trying to change your anxious beliefs unless you are clear about the content of these
beliefs. In addition to reviewing the anxious thoughts recorded in chapter 3, identify -
ing your anxious beliefs, predictions, and assumptions should be an ongoing process.
Whenever you find yourself in an anxiety-provoking situation, try to identify the specific
thoughts and beliefs that contribute to your discomfort. In most cases, you can identify
your anxious predictions and assumptions by asking yourself a series of questions such
as the following:
UÊWhat am I afraid will happen in this situation?
UÊWhat do I fear that the other person will think about me? | shyness_social.pdf |
210b8cb98990-1 | UÊWhat do I fear that the other person will think about me?
UÊWhat will happen if my anxious thoughts are true?
Sometimes it may be difficult to pinpoint your fearful thoughts. Chances are that
social anxiety has been a part of your life for so long that your negative thoughts are
well-rehearsed, very quick, and almost automatic (like habits). Also, the fact that you
probably avoid the situations you fear makes it that much more difficult to remember
exactly what thoughts tend to occur when you are actually in the situation.
If you have difficulty identifying your anxious beliefs, we suggest that you try to
engage with the situations you fear and attempt to identify your assumptions and predic -
tions while you are still in the situation. With practice, it should get easier to recognize
your anxious beliefs. In fact, even if you are unable to identify the specific thoughts that
contribute to your anxiety, practicing being in the situation will likely lead to a decrease
in your fear, as discussed in chapters 7 and 8. | shyness_social.pdf |
130384720597-0 | Changing Your Anxious Thoughts and Expectations
119STRATEGIES FOR CHANGING ANXIOUS THINKING
This section provides an overview of seven different techniques for changing the beliefs
and predictions that contribute to your social anxiety. These include (1) examining the
evidence for your beliefs, (2) challenging catastrophic thinking, (3) remembering your
strengths, (4) seeing yourself as others do, (5) examining the costs and benefits of your
thoughts, (6) creating rational coping statements, and (7) conducting behavioral experi -
ments. Along with a description of each strategy, we include exercises to provide oppor -
tunities to try each technique. Near the end of the chapter, we offer some suggestions
for tying together all the pieces and for integrating the cognitive therapy techniques into
your larger treatment plan.
Examining the Evidence
The fact that you are anxious about being judged by others in a particular situation
doesn’t mean that your fearful predictions and thoughts are true. In fact, what we assume
others are thinking is often completely different than what other people actually think
of us. How many times have you heard someone say, “My hair looks awful” or “I am
such a loser” and thought to yourself that the individual was just fine? If you are consis -
tently assuming you’re inferior in the eyes of others, you are probably exaggerating or
misinterpreting other people’s reactions to your appearance, behavior, or performance.
The first step toward changing your thoughts is to recognize that your beliefs are
not facts. Rather than assuming that your beliefs are true, it is important to treat your
anxious thoughts as guesses or hypotheses. By examining the evidence, you will be able
to assess the extent to which your beliefs are true. Remember, your natural tendency | shyness_social.pdf |
130384720597-1 | to assess the extent to which your beliefs are true. Remember, your natural tendency
may be to seek out only information that confirms your negative beliefs about yourself.
Examining the evidence involves trying to achieve a more balanced view by looking at all
the evidence, especially information that contradicts or disproves your anxious thoughts
and predictions.
In order to examine the evidence for your beliefs, we recommend you get into the
habit of asking yourself questions such as the following:
UÊHow do I know for sure that my prediction will come true?
UÊWhat does my past experience tell me about the likelihood of my thoughts
coming true?
UÊHave there been times when I have experienced anxious thoughts that
didn’t come true?
UÊAre there facts or statistics that can help me to decide whether my predic -
tion is likely to come true? | shyness_social.pdf |
960c557bbf03-0 | The Shyness & Social Anxiety Workbook
120UÊAre there other possible interpretations for this situation?
UÊHow might another person interpret this situation?
You may find it useful to type these questions on a small index card and carry that
card as a reminder in your pocket or wallet. Essentially, examining the evidence involves
four basic steps: identifying your anxious beliefs, generating alternative beliefs, weigh -
ing the evidence supporting and contradicting your beliefs, and choosing more realistic
beliefs. Asking questions similar to those listed above will help you to identify alternative
beliefs and to evaluate the evidence concerning your anxious and alternative beliefs. An
illustration of how to use this strategy to combat a fear of shaking during a presentation
appears below:
Steps for Examining the Evidence
1. Identify the Anxious Thought
UÊThe audience will think I am incompetent if they see my hands shaking
during my talk.
2. Generate Alternative Beliefs
UÊNobody will notice my shaking.
UÊOnly a small number of people will notice my shaking.
UÊPeople who notice my shaking will think I am tired or that I have had
too much coffee.
UÊPeople who notice my shaking will think I am feeling a bit anxious.
UÊIt is normal to shake sometimes, so people will think nothing of it if they
notice my shaky hands.
3. Examine the Evidence
Evidence Supporting Your Anxious Belief
UÊI believe that my shaking is very extreme.
UÊA few people have commented on my shaky hands over the years.
UÊI tend to notice when other people shake.
Evidence Supporting Your Alternative Beliefs
UÊI know others with shaky hands, and people don’t seem to think they
are incompetent. | shyness_social.pdf |
960c557bbf03-1 | are incompetent.
UÊWhen I notice other people shaking, I don’t think they are incompetent.
UÊOften people seem not to have noticed me shaking when I asked them
if it was noticeable. | shyness_social.pdf |
a67fea7ee1e0-0 | Changing Your Anxious Thoughts and Expectations
121UÊWhen people have noticed my shaking, they haven’t tended to treat me
differently.
UÊThe people in the audience know me well. I can’t imagine that their
opinions of me would change dramatically based on whether my hands
shook during a single presentation.
4. Choose a More Realistic Belief
UÊSome people may notice my shaky hands, but it’s unlikely that they will
think I’m incompetent.
The following form can be used as you begin to work on examining the evidence
supporting and contradicting your anxious beliefs. You may want to make copies of this
form so that you can continue to use it whenever you encounter a feared situation. | shyness_social.pdf |
ad233bc06894-0 | The Shyness & Social Anxiety Workbook
122Form for Examining the Evidence
Situation
Anxious Beliefs, Predictions, and Interpretations
Alternative (Non-Anxious) Beliefs, Predictions, and Interpretations
Evidence Supporting My Anxious Beliefs, Predictions, and Interpretations
Evidence Contradicting My Anxious Beliefs, Predictions, and Interpretations
Choosing a More Realistic Way of Thinking | shyness_social.pdf |
0799ff17a1d1-0 | Changing Your Anxious Thoughts and Expectations
123To further illustrate the process of examining the evidence, here is an example of a
discussion between Stephen and his therapist demonstrating how to first identify anxious
beliefs and then challenge those beliefs based on your past experiences.
Therapist: What are you afraid will happen if you attend your company picnic next
week?
Stephen: I am nervous that I won’t be able to come up with anything to say to anyone.
Everyone else will be talking about their children. I’m not in a relationship,
and I have no kids, so I will have nothing in common with any of them.
Therapist: How sure are you that you will have nothing to say?
Stephen: Probably about 90 percent.
Therapist: What that means is that nine out of ten times that you attend an event such
as this one, you have nothing to say. Is this really true? What happened at
last year’s company picnic?
Stephen: When I first arrived, it was difficult. I stood off to the side and didn’t say
much to others. After a while, people started to include me in their conver -
sations and it got easier. I think it was especially difficult last year because I
had just started at the company and didn’t know anyone very well.
Therapist: Were you able to think of things to say?
Stephen: At first, I struggled. I think it was harder for me than it was for the others,
but I was able to think of a few things to talk about, especially later in the
afternoon.
Therapist: Did everyone at last year’s picnic bring a partner or spouse? Did they all talk
about their children? | shyness_social.pdf |
0799ff17a1d1-1 | about their children?
Stephen: No. In fact, there are a few other single people at work. Last year, lots of
people ended up talking about work.
Therapist: Thinking back to last year’s company picnic, do you still think that you
won’t have anything to say at this year’s picnic?
Stephen: Well, I may not be as talkative as some other people, but I suppose I will
probably find something to talk about. Maybe it will be easier this year
because I’ve worked with these people for over a year, so I know them much
better. | shyness_social.pdf |
105565e8a59e-0 | The Shyness & Social Anxiety Workbook
124Challenging Catastrophic Thinking
Challenging catastrophic thinking requires shifting the focus of your thoughts from
how terrible a particular outcome would be to how you might manage or cope with
the situation if it were to occur. One of the most effective ways of overcoming your
catastrophic thoughts is to ask yourself questions like the following:
UÊSo what?
UÊWhat if my fears actually come true?
UÊHow can I cope with if it were to occur?
UÊWould really be as terrible as I think?
UÊDoes this really matter in the big scheme of things?
UÊWill I care about this a month from now? A year from now?
In many cases, you will realize that even if your fear does come true, it won’t be the
end of the world. You will cope with the situation, and your discomfort will pass. Below
you will see a discussion between Aimee and her therapist illustrating how to use this
technique to challenge catastrophic thoughts related to asking someone out on a date.
Aimee: I am terrified of asking anyone out on a date for fear of rejection.
Therapist: Is there a particular person whom you have considered asking out?
Aimee: There is a guy in one of my classes. I’ve sat with him a few times. The class
ends just before lunch, so I’ve thought of asking him to have lunch with
me.
Therapist: What’s stopping you? What do you think might happen if you ask him to
join you for lunch?
Aimee: Mostly, I am afraid he won’t be interested in me. I will put him on the spot | shyness_social.pdf |
105565e8a59e-1 | and he’ll have to come up with an excuse for rejecting my offer. I’m afraid
he’ll think I’m stupid, or even worse, he’ll feel sorry for me.
Therapist: As we’ve discussed previously, there are many different possible reactions
that he could have. Thinking you’re stupid or feeling sorry for you are just
two of many possibilities. Nevertheless, let’s assume for a moment that your
fears actually are true. What if he does think you are foolish and pathetic?
Aimee: I don’t know. I hadn’t really thought beyond that. I would feel terrible. | shyness_social.pdf |
4642f2abfd63-0 | Changing Your Anxious Thoughts and Expectations
125Therapist: Would it mean that you really are pathetic and stupid?
Aimee: I suppose not.
Therapist: Would it mean that all other people also think you are stupid and
pathetic?
Aimee: Not really.
Therapist: Why not?
Aimee: Well, his opinion doesn’t reflect that of other people. I know my friends
don’t think I’m pathetic. At least I hope not.
Therapist: If you’re not stupid or pathetic, why else would he reject you?
Aimee: Perhaps he might have other lunch plans. Or, maybe he already has a
girlfriend.
Therapist: Those are both possibilities, but let’s come back to your original thoughts.
What if he really thinks you’re pathetic and that’s why he isn’t interested in
spending time with you?
Aimee: I guess it wouldn’t matter. Over the past few weeks, I’ve come to recognize
that not everyone has to like me. Perhaps it would mean that we’re just not
a good match.
Therapist: If he declines your offer for lunch, do you think you will be able to cope
with the feelings of rejection?
Aimee: I think so. It will feel bad at first, but I think I can stop myself from getting
too down on myself.
Overcoming catastrophic thinking also involves combating the tendencies to con -
centrate only on the immediate consequences of some negative experience (for example,
“People will think badly about me during my presentation”) and to forget that your
discomfort will pass after a short time. In reality, the consequences of making a mistake | shyness_social.pdf |
4642f2abfd63-1 | discomfort will pass after a short time. In reality, the consequences of making a mistake
or of embarrassing yourself are usually minimal and almost never last very long. Even if
people notice that you have made a mistake or that you appear to be anxious, they are
likely to forget about it after a few minutes.
We have included a Decatastrophizing Form toward the end of this chapter to help
you challenge your catastrophic thoughts in social situations. The form includes three
columns. In the first column, you should describe the situation that led you to feel
anxious. In the second column, describe your anxious thoughts and predictions. Now,
ask the questions provided in the previous bulleted list (such as, “So what?”) and record
your noncatastrophic responses in the third column. Following are some examples. | shyness_social.pdf |
da23a6177dfa-0 | The Shyness & Social Anxiety Workbook
126Column 1 (Examples of Situations)
UÊGiving a presentation
UÊHaving difficulty thinking of things to say during a conversation
UÊAttending a party
UÊAsking someone out on a date
UÊWalking through a busy mall
Column 2 (Examples of Anxious Thoughts)
UÊ will think I am stupid.
UÊMy hands will shake.
UÊI will look weak or incompetent.
UÊ will feel sorry for me.
UÊMy anxiety will be noticed by .
Column 3 (Examples of Noncatastrophic Responses)
UÊEven if thinks I’m an idiot, it doesn’t mean I
really am one. His opinion doesn’t reflect that of everyone else.
UÊIt wouldn’t be the end of the world if noticed
my anxiety. Everyone feels anxious from time to time.
UÊWho cares if my hands shake? I have the right to have shaky hands. Probably
no one will even notice. Even if they notice, they probably won’t care. My
boss has shaky hands and nobody seems to care.
UÊIf I am ridiculed or laughed at, it would be manageable. Most people get
teased and ridiculed from time to time. I certainly laugh at other people
sometimes. Other than the temporary discomfort or embarrassment, it
wouldn’t really matter in the big scheme of things.
Remembering Your Strengths
If you tend to focus on small mistakes and perceived flaws in your personality or
appearance, you will likely continue to feel anxious. For example, if you assume that
everyone is judging you based on whether your hands shake, you are more likely to | shyness_social.pdf |
3aa4531cfdca-0 | Changing Your Anxious Thoughts and Expectations
127be nervous when your hands are shaking. Similarly, if you assume that everyone else
is criticizing you based on ten seconds during your presentation when you lost your
train of thought, you will probably continue to be nervous when giving presentations.
Although it is true that we all judge and criticize other people from time to time, it is
unlikely that people are noticing and judging the specific behaviors that you assume are
being criticized.
People’s judgments of one another are based on many different dimensions, includ -
ing appearance (for example, height, weight, hair color and style, facial features, cloth -
ing, shoes, and so on), intelligence (for instance, verbal abilities, problem-solving skills,
knowledge of trivia, and so on), competence (such as abilities to do one’s job well,
computer skills, ability to fix things around the house), work habits (for example, ten -
dency to arrive on time, work hard, and not take overly long breaks), athletic abilities
(like the ability to play tennis, fitness level, strength), creativity (for instance, musical
or artistic ability), health habits (such as diet, exercise, smoking, drinking), health status
(presence of medical problems), social status (type of home, income, type of job), mood
(happy, excited, sad, angry, fearful), and personality (generosity, empathy, confidence,
politeness, arrogance), to name just a few.
Most of us are far above average on some dimensions, far below average on some
other dimensions, and well within average range on most dimensions. The extent to
which a person criticizes you about a particular dimension probably depends on whether | shyness_social.pdf |
3aa4531cfdca-1 | which a person criticizes you about a particular dimension probably depends on whether
that person believes that particular domain is important. Although some people may
criticize you for appearing nervous, it’s likely that most people couldn’t care less. If you
assume others are focusing only on those dimensions in which you judge yourself to be
inferior, you will continue to feel anxious and fearful around other people.
Because your natural tendency may be to focus on those areas in which you feel you
don’t measure up to others, it may take some practice to recognize dimensions in which
you excel or in which you are similar to most other people. As a start, it may be helpful
to list some of your strengths in the space provided below.
Areas of Strength
Seeing Yourself as Others Do
One powerful method for challenging the overly harsh standards that you may hold
for yourself is to try to see anxiety-provoking situations through another person’s per -
spective. What if the tables were turned and a close friend came to you for advice and | shyness_social.pdf |
c5684cb59627-0 | The Shyness & Social Anxiety Workbook
128support after giving a presentation? What if your friend expressed many of the same
thoughts that you experience when you are in a feared social or performance situation?
What might you say?
For example, what if your friend said to you, “I totally blew my presentation. My
voice was trembling, and at one point I even lost my train of thought. I’m sure I looked
like a complete idiot.” How would you respond to your friend? Most likely you would say
something like, “You probably did better than you think. Even if you did look anxious,
people probably didn’t care.” Or, perhaps you would say something like, “I also feel very
anxious during presentations. It feels very uncomfortable in the moment, but eventually
it passes.”
It is often much easier to challenge someone else’s anxious thoughts than it is to
challenge your own. Therefore, we suggest that you try coping with your own anxious
thoughts by mentally “stepping out” of the situation for a moment. Imagine that it is
someone else (perhaps a close friend or family member) who is experiencing the anxiety.
What might you tell him or her? Taking the perspective of a close friend may help you
to challenge your own anxious thoughts.
Another helpful method of shifting perspectives is to imagine how you might judge
someone else who exhibits the same anxious behaviors that you do. For example, if you
are worried that others might criticize you if your voice become shaky, you might ask
yourself, “Am I critical of other people when I notice their voice shaking?” Most likely,
you would not assume someone else to be incompetent, stupid, or weak just because he
or she seems a bit shy or anxious in a particular situation. Well, the same is true of other | shyness_social.pdf |
c5684cb59627-1 | people. It is unlikely that they will make such harsh judgments of you, even if they do
notice that you’re anxious.
A third strategy for shifting perspectives is to ask yourself how someone who isn’t
anxious might interpret the situation you fear. For example, if you believe that it’s impor -
tant to avoid parties if there is any risk at all of looking anxious, you can ask yourself
how someone who isn’t anxious might view that situation. You can even imagine how
a particular person (for example, a friend, relative, spouse, or therapist) might view the
situation.
To summarize, shifting your perspectives involves asking yourself three types of
questions:
UÊWhat might I say to a close friend or relative who was having the same
thought as me?
UÊHow might I view someone else who was exhibiting the same behavior as
me (shaking, sweating, making a mistake, and so on)?
UÊHow might someone without an anxiety problem view this situation? | shyness_social.pdf |
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129Examining the Costs and Benefits of Your Thoughts
As we have discussed throughout this chapter, anxious thoughts about social and per -
formance situations are often untrue. However, sometimes they may be true (at least par -
tially true) and still be a problem. In addition to establishing whether your thoughts are
true, it’s useful to consider whether your thoughts and behaviors are helping you. If they
are helpful, then they may be worth holding on to. If not, it may be time to let them go.
Almost everyone wants to make a good impression and probably no one would
choose to be thought of as incompetent, stupid, boring, or weak. In fact, many of the
anxiety-provoking beliefs held by individuals with excessive social anxiety are similar in
content to those held by people who don’t have problems with social anxiety. Beliefs
such as “It is important to be liked by other people” and “It is important to make a posi -
tive impression” are often helpful beliefs that most of us develop early in life. Making a
good impression on others helps us to develop friendships, get promoted at work, and
impress our teachers. In fact, many rewards in life depend on being able to influence
others in a positive way.
However, excessive social anxiety is usually associated with a tendency to be overly
concerned with the opinions of others—so much so that it interferes with your life and
may actually lead to a more negative impression on others, particularly if you avoid
important social events. The problem with the beliefs and thoughts associated with
social anxiety is not necessarily that they are untrue (although sometimes they are), but | shyness_social.pdf |
39df7a14c974-1 | social anxiety is not necessarily that they are untrue (although sometimes they are), but
rather that they are held in an exaggerated and inflexible way. For example, if the belief
“I should make a good impression on others” motivates you to do a good job at work,
that’s great. If, on the other hand, the same belief makes you feel paralyzed and unable
to get any work done, that’s a problem.
In addition to establishing the accuracy of your anxious beliefs and predictions, it
may also be helpful to consider whether your thoughts and behaviors are helping you.
Following is a form that you can use for this exercise. If you are unsure about whether
a particular anxiety-provoking thought is true or false, try examining the costs and ben -
efits of constantly dwelling on the thought. How would the quality of your life improve
if you didn’t have the thought?
Describe Your Anxious Thought or Prediction
List the Benefits of Having That Anxious Thought or Prediction | shyness_social.pdf |
48f428d474ac-0 | The Shyness & Social Anxiety Workbook
130List the Costs of Having That Anxious Thought or Prediction
Rational Coping Statements
At the height of your fear, it may be difficult to challenge your anxious thoughts
using some of the techniques described in this chapter. You may find that your attention
is completely focused on trying to get through the situation, and it may seem impossible
to think logically. Rational coping statements are relatively easy to use and don’t require
the same level of logical analysis as other techniques, such as examining the evidence
and evaluating the costs and benefits of your anxious thoughts. Rational coping state -
ments are short “nonanxious” sentences that may help to combat your anxious thinking.
Examples include the following:
UÊIt would be manageable if didn’t like me.
UÊIt’s okay to blush in front of others.
UÊPanic attacks are uncomfortable but not dangerous.
UÊIt is okay to look anxious during a presentation.
UÊPeople don’t seem to notice my shaky hands.
You may find it helpful to write or type several coping statements on an index card
and carry the card with you as a reminder. When you are in an anxiety-provoking situ -
ation, you can take the card out of your wallet or purse and remind yourself of one or
more of these statements, thereby combating your anxious thoughts. Choose statements
that are most relevant to you. Also, choose statements that are believable. For example,
there is no point telling yourself, “I am not going to be anxious” if you always feel
anxious when giving speeches and you are about to give a speech. A more believable
alternative is, “It’s not the end of the world if I become anxious.” | shyness_social.pdf |
48f428d474ac-1 | alternative is, “It’s not the end of the world if I become anxious.”
In the following spaces, record five rational coping statements that are relevant to
your own particular anxious beliefs.
1.
2.
3. | shyness_social.pdf |
1cf3b2bf0eb6-0 | Changing Your Anxious Thoughts and Expectations
1314.
5.
Behavioral Experiments
Cognitive therapy involves examining the validity of your beliefs and thoughts in
the same way that a scientist examines the validity of a scientific theory or hypothesis.
In fact, the experiment is the most powerful strategy scientists have to test their own
beliefs. In cognitive therapy for social anxiety, experiments involve challenging anxious
beliefs by setting up small behavioral tests to see whether a belief is in fact valid. Through
a series of repeated behavioral experiments, it is likely that you will disprove many of
the beliefs and predictions that contribute to your fear and anxiety. Some examples of
specific experiments that can be used to test the validity of various anxiety-provoking
thoughts are listed below.
Anxiety-Provoking Thought Example of Behavioral Experiment
It would be terrible to have my hand
shake while I hold a glass of water.Purposely shake your hand while you hold
a glass of water. For a true test of your
beliefs, let the water spill all over you!
Then see if it really is so terrible.
I will make a fool of myself at my job
interview tomorrow, so why bother going?Go to the job interview and see what
happens.
I can’t cope with being the center of
attention.Do something to draw attention to your -
self. For example, arrive to class late, drop
your keys, wear your shirt inside out, or
knock over some unbreakable items in a
supermarket.
It would be terrible to seem stupid or
incompetent.Line up at a store and after your items
have been rung up, explain to the cashier
that you have forgotten your money. | shyness_social.pdf |
1cf3b2bf0eb6-1 | have been rung up, explain to the cashier
that you have forgotten your money.
I will be rejected if I ask a coworker to
have dinner with me.Invite your coworker for dinner and check
out his or her reaction.
When selecting possible experiments, try to choose practices in which you have
little to lose. For example, don’t tell your boss how much you hate him, just to see what
happens! Try to select experiments in which the worst that will happen is possible dis -
comfort or temporary embarrassment. Remember that the more social risks you take, the
more often they will pay off. Along the way, however, you will also experience rejection
from time to time. If you don’t take risks, you will never be rejected—but you will also | shyness_social.pdf |
f1613a2bf5d1-0 | The Shyness & Social Anxiety Workbook
132never experience the benefits of taking social risks, including improved relationships, a
better job, and other possible rewards.
In the spaces below, imagine and record some experiments you could try in order to
test out your particular anxious thoughts. In the first column, write down your anxious
belief. In the second column, design a small experiment that will provide a good test of
whether your belief is true.
Anxious Thought Behavioral Experiment
The next few chapters discuss strategies for confronting the very situations and
feelings that you fear. As you will see, exposure to feared situations is actually a type
of behavioral experiment. By repeatedly exposing yourself to situations that make you
anxious, you will learn that your fears often don’t materialize.
USING A THOUGHT RECORD OR
COGNITIVE DIARY
Throughout this chapter, we have included various forms and diaries to be used for
challenging anxious thoughts. In this section, we now provide a more general Social
Anxiety Thought Record that can be used whenever you experience anxiety in a social
situation. Unlike the other forms in this chapter, which are each designed for use with a
particular technique (examining the evidence, overcoming catastrophic thinking, and so
on), the Social Anxiety Thought Record is designed to be used with any of the cognitive
strategies. At the end of this chapter is a blank form, as well as a completed sample.
It really doesn’t matter which form you use to record and change your thoughts. You
can use the forms provided in this chapter, or you can design your own. The diaries in
this chapter are only suggestions. The main point of these diaries is to get you into the | shyness_social.pdf |
f1613a2bf5d1-1 | habit of paying attention to your thoughts and actively trying to change them. Once
the new patterns of thinking become second nature, it will no longer be necessary to
record your thoughts on paper. In the meantime, we recommend that you use some
type of diary or form several times per week after encountering feared social or perfor -
mance situations. The best times to complete the forms are either before entering the
situation (as a way of preparing for the encounter) or immediately afterward (as a way of
challenging any anxious thoughts that occurred while you were in the situation). | shyness_social.pdf |
23298cb9a829-0 | Changing Your Anxious Thoughts and Expectations
133Instructions for Completing the Social Anxiety
Thought Record
Column 1: Date and Time
Record the date and time.
Column 2: Situation
Describe the situation or trigger for your fear. Typical examples might include the
following:
UÊGave a presentation
UÊWent to a meeting
UÊPerson was watching me on the subway
UÊAte lunch with a coworker
UÊI was blushing
UÊMy hands shook in front of my boss
UÊWent to a party
UÊHad to do an oral book-report for class
UÊWas introduced to my sister’s new boyfriend
UÊWent on a blind date
Column 3: Anxiety-Provoking Thoughts and Predictions
In the third column, list any anxious thoughts that occur in response to the situa -
tion and triggers reported in column 2. Usually these thoughts will be predictions of
danger, embarrassment, and so on. Often these thoughts will be automatic or almost
unconscious. It will take practice to identify them. Try to come up with very specific
thoughts. A thought such as, “Something bad will happen” is too vague. Typical examples
of specific anxious thoughts include the following:
UÊPeople will notice my blushing and think I am strange
UÊPeople will notice that I am nervous
UÊI will make a fool of myself
UÊPeople will think I am stupid
UÊPeople will see me for the idiot I really am | shyness_social.pdf |
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134UÊPeople will think I’m ugly
UÊI will have to leave the situation
UÊI am incompetent and clumsy
UÊI need an alcoholic drink to feel comfortable
UÊPeople can always tell how I am feeling
UÊAnxiety is a sign of weakness
UÊI’ll be viewed as boring
UÊPeople will not like me
UÊI will have nothing to say
Column 4: Anxiety Before (0–100)
Rate your anxiety level before countering your anxiety-provoking thoughts. Use a 0
to 100 point scale, where 0 = no anxiety and 100 = extreme anxiety.
Column 5: Alternative Thoughts and Predictions
Record examples of alternative thoughts and predictions. For example, if you believe
that people will think you are strange if you blush, alternative predictions might include
such thoughts as (1) nobody will notice my blushing, (2) people who notice my blushing
will think I am hot or not feeling well, and (3) people who notice my blushing will think
nothing of it.
Column 6: Evidence and Realistic Conclusions
Consider the evidence for your anxiety-provoking thoughts as well as your alterna -
tive thoughts. For example, if you fear blushing, you might record your observations that
most people don’t mention that they notice your blushing, and that even when people
do notice that you are blushing, they still seem to enjoy your company and they still
treat you well. In this column, you should also record a realistic conclusion based on the
evidence. For example, you might record, “Many people don’t seem to notice my blush - | shyness_social.pdf |
db4db4bd2e66-1 | ing, and even when someone does notice it, there are no real consequences other than
my temporary embarrassment.”
Column 7: Anxiety After (0–100)
Rate your anxiety level after countering your anxiety-provoking thoughts. Use a 0
to 100 point scale, where 0 = no anxiety and 100 = extreme anxiety. | shyness_social.pdf |
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135INTEGRATING COGNITIVE STRATEGIES INTO
YOUR TREATMENT PLAN
The cognitive techniques described in this chapter are not meant to be used on their
own. Rather, they should be used as part of a comprehensive treatment plan that includes
exposure to feared situations. Exposure-based treatments are discussed in chapters 7
through 9. We recommend that you first practice the cognitive techniques for a few
weeks before formally beginning exposure practices. Learning to manage your anxiety
by changing your thinking will help you when confronting the situations that you fear.
In addition to exposure and cognitive therapy, your treatment may also include medica -
tion (see chapter 5) and social-skills practices (see chapter 10), depending on your own
personal needs and preferences.
A WORD TO SIGNIFICANT OTHERS, FRIENDS,
AND FAMILY MEMBERS
If you are working with a loved one who is trying to overcome his or her social anxiety,
you can help him or her to change anxiety-provoking thoughts into more realistic
thoughts by engaging in calm, logical discussions about the situations he or she fears.
This process should always be done in a supportive way, and you should be careful
not to put your loved one down for having anxiety-provoking beliefs (after all, we all
have irrational thoughts from time to time). You should also be careful not to tell your
loved one what he or she should be thinking. Rather, your loved one should draw his or
her own conclusions based on the evidence. Finally, remember that your role is to be
supportive—not to nag or pressure your loved one into making changes or to argue
about how to interpret anxiety-provoking situations. You and your loved one should | shyness_social.pdf |
2f723644bed0-1 | about how to interpret anxiety-provoking situations. You and your loved one should
discuss what role he or she would like you to have, and how you can best facilitate the
process of change.
TROUBLESHOOTING
Problem: I have difficulty identifying my anxious thoughts.
Solution: Ask yourself questions such as, “What might think
about me?” and “What do I think will happen in this situation?” If, after
trying to answer these questions, you are still unable to identify your
anxious beliefs, try to detect your thoughts while you are actually in
the situation you fear. If you are unable to identify specific thoughts and
predictions, don’t worry. You can still benefit from the exposure-based
strategies discussed in chapters 7 through 9. | shyness_social.pdf |
7190c10cf3e1-0 | The Shyness & Social Anxiety Workbook
136Problem: I have difficulty believing the alternative, nonanxious, rational
thoughts.
Solution: Sometimes the cognitive techniques seem superficial when a person first
starts to use them. Over time, the new nonanxious thoughts should
become more believable. If not, the exposure-based strategies (chap -
ters 7 through 9) are among the most powerful methods for changing
anxious thoughts and will likely help. Sometimes, changing thoughts
through firsthand experience in a feared situation is more effective than
trying to change thoughts by simply trying to think differently.
Problem: When I am in a social situation, I am too anxious to think clearly, so I
can’t use the cognitive strategies.
Solution: Try using the cognitive strategies before you enter the situation. If this
is not practical, try using them after you have been in the situation for
a while (your fear should decrease over time) or even after leaving the
situation.
Problem: I can’t be bothered completing the monitoring forms. They are confus -
ing, and they take too long to complete.
Solution: There are many different ways to learn the techniques described in
this chapter. The forms and diaries are designed to make the process
easier. However, if they are getting in the way of using the strategies,
try developing a simpler form (for example, you may want to use a two-
column form—with one column for recording your anxious thoughts
and another column for recording your new nonanxious thoughts).
Alternatively, you can even forget about the forms and diaries and
simply use the techniques in your head. | shyness_social.pdf |
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137A SUMMARY GUIDE TO CHALLENGING
THOUGHTS
This chapter includes a large number of suggestions and strategies for identifying and
changing your anxious thoughts. Now that you have had a chance to read through the
chapter and complete some of the exercises, we encourage you to continue using the
cognitive techniques to cope with your social and performance anxiety. Generally, using
the cognitive strategies will involve the following steps:
1. Identify your anxious thoughts, predictions, and interpretations.
2. Examine the validity of your anxious predictions using some of the tech -
niques described in this chapter (such as examining the evidence, taking the
perspective of others, examining the costs and benefits of your thoughts,
conducting behavioral experiments). Are your predictions realistic? For
example, will others really think about
you?
3. Examine the validity of your catastrophic thoughts by asking the question,
“So what if my anxious thoughts are true?” For example, “What if a few
people in the audience really think my presentation is awful? How might I
cope with that?”
4. Use the Social Anxiety Thought Record to identify and challenge your
anxious thoughts on paper. | shyness_social.pdf |
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138
Decatastrophizing Form
Situation Anxious Thoughts and Predictions
(What do I think will happen?)Noncatastrophic Responses
(What if my thoughts come true?) | shyness_social.pdf |
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139Social Anxiety Thought Record
Date and
TimeSituationAnxiety-Provoking
Thoughts and
PredictionsAnxiety
Before
(0–100)Alternative Thoughts
and PredictionsEvidence and Realistic
ConclusionsAnxiety
After
(0–100)
© 2008 Martin M. Antony | shyness_social.pdf |
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140
Social Anxiety Thought Record—Completed Sample
Date and
TimeSituationAnxiety-Provoking
Thoughts and
PredictionsAnxiety
Before
(0–100)Alternative Thoughts
and PredictionsEvidence and Realistic
ConclusionsAnxiety
After
(0–100)
April 3,
2 PMMeeting at work I will say something stupid;
people will think I’m an idiot.90 I will say something intel -
ligent. I will say something
that is neither stupid nor
intelligent. Some people will
think I’m smart; some people
may think I am of average
intelligence. Whatever I
say won’t change what my
coworkers already think about
my intelligence. My boss asked me to speak at the meeting,
so she must think I have something worth -
while to say. Everyone says stupid things
from time to time, and there is no reason to
think that I shouldn’t also say dumb things
sometimes. Nothing terrible will happen if I
say something stupid. Everyone in the room
already knows me. Even if someone thinks I
am stupid, it won’t be the end of the world.50
April 5,
7 PMEating dinner with
a friend; my hands
are shakingMy shaking hands will be
noticeable. My friend will
think that I am nervous and
will see that as a weakness.70 Maybe my friend won’t
notice my hands shaking.
Even if he notices, he may
not think it is due to anxiety.
Even if he thinks it is due to
anxiety, he may not see it as
a weakness. | shyness_social.pdf |
e8b63b9d2003-1 | anxiety, he may not see it as
a weakness.
I have known my friend for years. He
knows that I get nervous sometimes, and he
still wants to spend time with me. He gets
nervous in situations that don’t bother me
(he is afraid of flying). I have the right to
have shaky hands sometimes!
45 | shyness_social.pdf |
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141April 7,
3 PMReturning an item
to a storeThe cashier will think I’m
stupid for buying this item in
the first place. I won’t be clear
when trying to explain what
I want to do. The cashier
won’t let me return the item,
and I won’t know how to
respond.70 The cashier will not think I
am stupid. I will be able to
explain what I want to do.
The cashier will allow me to
return the item. Even if I am
anxious, I will be able to cope
with this situation.I have returned items to stores before, and it
always seems to work out. Chances are that
it will work out this time, too. Returns are
allowed within 30 days, so I have the right
to return this item. Even if I seem nervous,
the cashier doesn’t have the right to turn
down my request. If I can’t think of the
right words, I can just take my time until
the words come to me. 20
© 2008 Martin M. Antony | shyness_social.pdf |
8737838f3451-0 | CHAPTER 7
Confronting Your Fears
Through Exposure
Chapter 6 provided a detailed overview of cognitive strategies that have been shown to
be useful for changing anxious patterns of thinking. Almost all of the cognitive tech -
niques involve learning to think differently about social and performance situations by
(1) broadening the possible range of interpretations and beliefs that you can hold for a
particular social situation, and (2) considering all the evidence before assuming that a
specific thought is true.
This chapter provides an introduction to a number of techniques that are useful for
changing the behaviors that maintain your anxious beliefs and feelings. Essentially, these
strategies involve confronting your fears directly by exposing yourself to the situations
and the feelings that you currently fear and avoid. This chapter starts with a review of
the behaviors that contribute to social anxiety and a summary of the strategies that can
be used to change these behaviors. The remainder of the chapter provides more detailed
descriptions of the underlying principles of exposure and the best ways of conducting
exposure-based therapy.
Chapters 8 and 9 build directly on the content of this introductory chapter by provid -
ing more in-depth instructions for exposure to social situations (chapter 8) and exposure
to feared sensations (chapter 9). The exercises described in chapters 7 through 9 should
be used after you have had a chance to practice some of the cognitive methods described
in chapter 6. We recommend that you begin to learn about exposure by reading chapters
7 and 8 and that you practice the situational exposure exercises for at least three to five
weeks before moving on to chapter 9. Then, we suggest that you read chapter 9 and make
some attempts to expose yourself to feared sensations, if these exercises are relevant | shyness_social.pdf |
8737838f3451-1 | some attempts to expose yourself to feared sensations, if these exercises are relevant
to you. As reviewed in chapter 9, exposure to physical sensations may be useful if you | shyness_social.pdf |
17cb5b33b843-0 | The Shyness & Social Anxiety Workbook
144are fearful of experiencing particular feelings (for instance, sweating, shaking, blushing,
racing heart) associated with being anxious or nervous. If you are not fearful of these
behaviors, then the strategies described in chapter 9 will not be as important.
BEHAVIORS THAT CONTRIBUTE TO
SOCIAL ANXIETY
All organisms try to avoid situations that cause fear, pain, or discomfort. Avoidance is a
method of protecting oneself from possible danger. In the short term, staying away from
perceived threats is a very effective way of decreasing or preventing these uncomfort -
able feelings. Your experience has probably taught you that confronting feared situations
causes you to feel overwhelmed and that avoiding or escaping from feared situations
leads to a sense of relief. However, avoiding the situations, objects, and feelings that
make you anxious is also a guaranteed way to ensure that your fear will continue over the
long term. The likelihood of threat in the social situations that you avoid is probably very
low. Avoidance can actually do more harm than good, particularly in the long term.
By avoiding the situations that make you uncomfortable, it may seem as though you
prevent your feared negative consequences from occurring. Just as a person who fears
flying may believe that avoiding a flight has protected him or her from experiencing
a possible plane crash, you may believe that avoiding social or performance situations
protects you from experiencing various social catastrophes, such as being humiliated or
criticized by others. Of course, statistically, the risk of dying in a plane crash is close
to zero (about one in ten million, according to some sources). In other words, the risk | shyness_social.pdf |
17cb5b33b843-1 | of being in a plane crash is almost identical (close to zero) whether you fly or not! The
same may be said of public speaking, attending parties, and other social situations. The
risk of actual threat or danger is significantly less than socially anxious individuals usually
assume. In fact, the long-term consequences of avoiding social situations are often far
greater than the risks of confronting these situations.
Exposure to feared situations and feelings is a very powerful method of learning that
avoidance is neither necessary nor helpful in the long run. By confronting your fears, you
will discover that many of your anxiety-provoking beliefs and interpretations are untrue
or exaggerated. In addition, your interpersonal skills will improve as you will have more
opportunities to practice various types of social interaction and performance. In other
words, not only will you become more comfortable making small talk, giving speeches,
or dealing with conflict situations, you will also become more effective and competent
at mastering these challenging situations.
There are three main types of anxious behaviors that we will review here. Each of
these is a potentially harmful habit because it prevents your fear from decreasing over
the long term. These behaviors include (1) avoiding feared social and performance situa -
tions, (2) avoiding feared sensations and feelings, and (3) subtle avoidance strategies and
safety behaviors. | shyness_social.pdf |
99de454ac36c-0 | Confronting Your Fears Through Exposure
145Avoidance of Social Situations
Avoiding social situations such as public speaking, making conversation, attending
meetings, dating, and working out at the gym prevents you from learning that these
situations are safe and that your fears are generally unwarranted. Escaping early from
these situations (for instance, leaving a party after a few minutes) can also have a nega -
tive impact on your fear by reinforcing your experience that being in the situation makes
you uncomfortable, and leaving the situation provides relief and a reduction in fear. In
reality, staying in a situation despite the fear that it arouses also leads to a reduction in
fear. Fear may take longer to decrease when you stay in the situation, but the long-term
benefits will be greater. By staying until your fear decreases, you will learn that you can
be right in the middle of the situation and feel relatively comfortable. Strategies for
overcoming avoidance of feared situations are discussed throughout this chapter, as well
as in chapter 8.
Avoidance of Feared Sensations
As we discussed previously, in addition to avoiding certain situations, you may also
avoid feeling certain sensations or feelings, particularly in social situations. Perhaps you
avoid eating hot foods that cause you to feel flushed when you’re dining with friends or
relatives. Alternatively, you may avoid wearing warm clothes while speaking in public, in
case they cause you to sweat. Avoiding sensations such as sweating and blushing reinforces
your beliefs that these sensations and feelings are dangerous. If you are fearful of expe -
riencing particular symptoms in the presence of others, you will likely find that exposing
yourself to these feelings can help you to become more comfortable with them. The goal | shyness_social.pdf |
99de454ac36c-1 | yourself to these feelings can help you to become more comfortable with them. The goal
is to reach a point at which sensations, like shaking or a racing heartbeat, are, at worst,
mildly uncomfortable but not frightening. The general principles discussed throughout
this chapter will be relevant to overcoming your fear of physical symptoms. However,
specific exercises for overcoming these fears are discussed more thoroughly in chapter 9.
Subtle Avoidance Strategies and Safety Behaviors
Subtle avoidance behaviors (also called safety behaviors ) are not-so-obvious strate -
gies that people often use to cope with anxiety-provoking situations. Unlike completely
avoiding a feared situation, subtle avoidance strategies involve partial avoidance of the
situation. Often these behaviors are not noticeable to others. In fact, they may be so
subtle that even you are not aware of them. As is the case with more obvious types of
avoidance, learning to let go of your subtle forms of escape will help you to overcome
your fear, just as removing training wheels is an important step in learning to ride a
bicycle, and letting go of crutches is an important step in relearning to walk after an
injury. We will now discuss some examples of subtle avoidance strategies. | shyness_social.pdf |
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146Distraction. Distraction involves escaping from anxious thoughts and feelings by focus -
ing on thoughts or images that are more pleasant or by keeping yourself busy with
distracting activities. For example, while attending a party, you might offer to help serve
food or drinks so that you are constantly busy with some activity and your mind is dis -
tracted from the anxious feelings that you might otherwise be experiencing. Or, while
traveling on a bus or train, you might always be sure to bring a book or portable radio
to distract yourself from feeling anxious about making eye contact with others or from
thinking about what others might be thinking about you. Such distractions may help you
to feel comfortable while in social or performance situations, but in the long term they
prevent you from learning that you can manage the situation without having to rely on
subtle avoidance.
Overprotective behaviors. Overprotective behaviors are small things that you may do
to feel safer in the situations that you fear. Examples may include the following:
UÊWearing extra makeup or a turtleneck sweater to hide blushing
UÊFinding out who else will be at a party before deciding whether to attend
UÊWearing gloves to hide shaking hands
UÊSitting down or leaning against a podium while giving a presentation
UÊEating in a dimly lit restaurant so your date won’t notice your anxiety
UÊWearing sunglasses to help avoid making eye contact
UÊAlways attending social events with a friend so you can avoid talking to
people who you don’t know well
When designing exposure practices, it is important that you also try to eliminate
these subtle safety behaviors.
Overcompensating for perceived deficits. Overcompensating involves working extra | shyness_social.pdf |
cbd374f221c4-1 | hard to make sure that your fearful predictions don’t come true. For example, if you
are afraid of looking foolish during a presentation, you may spend days rehearsing and
memorizing what you will say. If you’re fearful of making small talk, you may spend
hours preparing topics of conversation and rehearsing what you might talk about. If
you are afraid of looking unattractive, you may put too much effort into fixing your
hair, choosing your clothes, or building your muscles at the gym. In many cases, these
situations might be managed with less effort, leaving time and energy for other things.
Exposure practices should be designed to eliminate any tendencies to overprepare or
overcompensate for flaws that may not even be present. For example, instead of spend -
ing hours memorizing a presentation, try giving your talk with only minimal (but still
adequate) preparation. | shyness_social.pdf |
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147Excessive checking and reassurance seeking. Excessive checking involves spending too
much time and effort trying to find out whether you are perceived by others in a positive
light. We all engage in occasional checking (for example, looking in the mirror at a party,
asking a coworker whether she enjoyed your presentation). In fact, we recommend that
you occasionally continue to check on other people’s reactions to you and your actions.
Checking and receiving reassurance are helpful ways of testing out your beliefs. However,
if you ask for reassurance or check too frequently, this may be a behavior you want to
decrease. The key is moderation. Occasional checking is helpful, but constant checking
can be a problem. Constantly obtaining reassurance about your performance is like con -
stantly checking with your doctor whenever you experience an unusual sensation. Never
going to the doctor may cause you serious health problems that might otherwise have
been detected early or prevented. But going to the doctor several times a week to check
out every ache and pain can backfire; your doctor may stop taking your concerns and
complaints seriously. Constant requests for reassurance can also backfire, having the exact
effect that you are trying to avoid—namely a negative response from others.
Substance use. Substance use can undermine the effects of exposure by artificially low -
ering your level of fear in social and performance situations. For exposure to be effec -
tive, it’s important for you to experience some degree of fear. It is also important for
you to learn that your fear will usually decrease naturally if you stay in the situation.
Drinking alcohol or using other drugs whenever you are in a situation that makes you | shyness_social.pdf |
80e8c4d1120c-1 | Drinking alcohol or using other drugs whenever you are in a situation that makes you
anxious will prevent you from learning that your anxiety will decrease even without the
drug or alcohol. When designing exposure practices, we recommend that you not drink
alcohol or use drugs during the practice. If you want to have a glass of wine or a beer at
a party, try to wait until after your fear has decreased somewhat.
A STEP-BY-STEP OVERVIEW FOR CONDUCTING
EXPOSURE-BASED TREATMENTS
The main steps involved in any exposure-based treatment program are initial assessment,
planning appropriate practices, carrying out the practices, and taking steps to maintain
the improvements over the long term.
Initial Assessment
We discussed the issue of assessment in chapter 3. To plan effective exposure prac -
tices, you will need to know the situations and sensations that you fear and avoid as
well as becoming aware of the different variables that affect your fear level. When you
completed the exercises in chapter 3, you probably identified a number of variables
that affect your fear level when you are in a social or performance situation that causes
you to feel uncomfortable. You should review the relevant sections of chapter 3 before
beginning your exposure practices. | shyness_social.pdf |
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148Planning Appropriate Practices
Planning your exposure practices starts with developing an exposure hierarchy . An expo -
sure hierarchy is a list of feared situations ranked in order of difficulty, from least fear
provoking at the bottom, to most fear provoking at the top. Chapter 8 provides exam -
ples of hierarchies and includes instructions on how to develop your own hierarchy for
situational exposure. Chapter 9 provides sample hierarchies and instructions for devel -
oping a hierarchy for exposure to feared sensations. Developing an exposure hierarchy
will provide a structure that will allow you to begin with easier exercises and work your
way up to more difficult ones.
Carrying Out the Practices
Once you’ve identified some practices likely to be helpful, the next step is to begin
carrying them out. Generally, exposure begins with more manageable situations and
works up to more and more difficult situations. As confronting the situations becomes
easier, you should begin to let go of the subtle forms of avoidance that were discussed
earlier. Later, after practicing situational exposure for several weeks (as described in
chapter 8), it may be useful to add exercises involving exposure to feared feelings and
sensations (as described in chapter 9).
Exposure practices should be structured, planned in advance, and carried out fre -
quently. The ways in which exposure practices are carried out affect whether the prac -
tices are helpful or not. Exposure can actually increase your fear if not done properly.
The remaining sections of this chapter provide suggestions for the best ways to conduct
exposure to maximize the chances of decreasing your fear.
Maintaining Your Improvements
In order to maintain your improvements, it’s important that you continue occasional | shyness_social.pdf |
fca42db049a1-1 | In order to maintain your improvements, it’s important that you continue occasional
practices even after your fear has decreased. These strategies are explored in greater
detail in chapter 11.
TYPES OF EXPOSURE
This section discusses three different dimensions that should be taken into account when
planning exposure practices. They are (1) exposure to social situations vs. feared sensa -
tions; (2) imagined vs. live exposure; and (3) gradual vs. rapid exposure. | shyness_social.pdf |
916578083359-0 | Confronting Your Fears Through Exposure
149Exposure to Social Situations vs. Feared Sensations
Situational exposure involves exposing oneself to places and situations that produce
anxiety. Overcoming social and performance anxiety almost always includes situational
exposure as a component. In other words, to become more comfortable with public
speaking, meeting strangers, or lunching with your coworkers, you will need to practice
these activities.
Some people with social and performance anxiety may also benefit from exposure to
sensations. This form of exposure is sometimes called interoceptive exposure, and it involves
practicing exercises that trigger particular physical sensations. For example, spinning in a
chair can be used to induce dizziness, and running up and down the stairs will make your
heart race. Exposure to sensations is useful for people who are fearful of experiencing
uncomfortable physical feelings.
If you are not afraid of the physical sensations that you experience when anxious,
there is no need to practice these exercises. However, if you are frightened by the physi -
cal sensations you experience in social situations, you may find it helpful to practice
experiencing these feelings purposely until they no longer frighten you. Exposure to
sensations can be combined with situational exposure so that feared physical feelings are
purposefully brought on during the course of the exposure to feared situations. Chapter
9 provides a detailed description of how to use interoceptive exposure to reduce your
fear of sensations.
Imagined vs. Live Exposure
Exposure can be conducted in your imagination (imagining being in a feared situa -
tion) or in real life (actually entering the feared situation). Generally, whenever possible,
we recommend that live exposure (also called in vivo exposure ) be used rather than imag - | shyness_social.pdf |
916578083359-1 | we recommend that live exposure (also called in vivo exposure ) be used rather than imag -
ined exposure. Although both approaches can lead to a reduction of fear, live exposure
has two big advantages. First, some people have difficulty imagining feared situations in
a way that actually arouses their fear; and, second, there is evidence that live exposure
is more effective at reducing fear (Emmelkamp and Wessels 1975).
Nevertheless, under certain circumstances, imagined exposure may be helpful. If
you are too fearful to enter a situation in real life, you can use imagined exposure as a
stepping-stone to the real situation. For example, if you are planning to ask someone out
on a date, you might consider using an imagined exposure to the situation at first. Once
you have become more comfortable imagining the situation, trying the real thing might
become easier. Also, imagined exposure can be helpful when the situation is impracti -
cal or impossible to practice in real life. For example, if you must give a presentation
to a group of 200 people, you may not be able to practice it in front of a large group.
Instead, imagining a large group in your mind’s eye might be a good way to practice for
the actual presentation when you are preparing your talk. | shyness_social.pdf |
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150Situational role-play is a compromise between imagined exposure and live exposure.
Role-play involves rehearsing being in a particular situation with the help of a friend,
family member, or therapist. For example, before exposing yourself to a real job interview,
you could practice mock interviews with other individuals posing as the interviewers.
Or, you could ask your family or friends to act as the audience while you practice a pre -
sentation. These various forms of situational exposure (imagined, in vivo, and role-plays)
are discussed more thoroughly in chapter 8.
Gradual vs. Rapid Exposure
Exposure may be conducted gradually or rapidly. Rapid exposure involves taking
steps very quickly, skipping steps, and sometimes trying more difficult situations before
you have completely mastered easier situations. For example, rapid exposure to public
speaking might have you start off with talking in front of large groups of unfamiliar
people instead of to small groups of familiar people.
Gradual exposure tends to begin with easier practices and progresses to the more
difficult practices much more slowly. Compared with rapid exposure, a person who is
working on gradual exposure may spend more time practicing each step before moving
on to the next level of difficulty. In addition, gradual exposure is less likely to leave out
intermediate steps, compared with rapid exposure. With gradual exposure, by the time
you get to the top steps of your hierarchy, you will be better prepared and less likely to
feel overwhelmed by the practice.
Gradual exposure is similar to progressing through school one grade at a time. If
you had to jump from ninth grade to twelfth grade, you would likely find the increase | shyness_social.pdf |
926972411e6e-1 | in difficulty overwhelming. By progressing through high school one grade at a time, you
find each grade to be just slightly more difficult than the previous grade. By the time
you get to twelfth grade, the increase in difficulty is only a small step compared with
your work in eleventh grade.
Gradual exposure to public speaking might begin by presenting small speeches in
front of a close friend or family member or by asking questions at meetings. After those
practice situations become easier, you might try speaking for longer periods of time
during meetings or practicing a speech in front of a small group of friends or family
members. This could then progress to practicing your speech in front of several cowork -
ers. With gradual exposure, you might not actually speak in front of large groups of
unfamiliar people until many earlier steps have been mastered.
Gradual and rapid exposure are both effective ways of reducing fear, and the end
result of each is usually the same. However, each approach has advantages and disadvan -
tages over the other. With rapid exposure it is likely you will see changes more quickly,
which will save you time. Also, these quick results may motivate you to work even harder
at overcoming your fear, just as seeing quick changes in your weight or fitness level can
motivate you to stick to an exercise and healthy-eating plan. However, compared with
gradual exposure, rapid exposure is associated with higher levels of discomfort and fear. | shyness_social.pdf |
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151Rapid exposure requires a strong commitment from you to tolerate higher levels of
discomfort.
The differences between these two forms of exposure can be compared to the
difference between jumping into a cold swimming pool and entering the pool slowly.
Jumping into the pool quickly causes more initial discomfort, but you get used to the
water more quickly. On the other hand, getting into the pool slowly and gradually may
be less shocking to your system, but it will take you longer to get used to the water.
We recommend that you practice exposures as quickly as you are willing to. If you
are able to take steps more quickly, you will overcome your anxiety more quickly. If
you prefer a more gradual approach, that’s fine, too. Sometimes, you may find it dif -
ficult to judge whether a particular step is too difficult. Remember, there is no harm in
taking steps too quickly. If an exercise ends up becoming too overwhelming, you have
the option of continuing to practice it until it becomes easier or stepping back, trying a
less difficult exercise, and working your way up to the difficult practice more gradually.
Either approach is likely to be helpful. The decision is a matter of personal preference
and how much discomfort you’re willing to tolerate.
HOW EXPOSURE WORKS
Many cognitive-behavioral researchers and therapists believe that exposure works by
providing individuals with an opportunity to test the validity of their fearful thoughts,
assumptions, and interpretations. In chapter 6, we discussed the use of behavioral experi -
ments for challenging anxious beliefs and predictions. Repeated exposure may be thought
of as a form of behavioral experiment. By entering feared situations and exposing your - | shyness_social.pdf |
895b81644d6a-1 | of as a form of behavioral experiment. By entering feared situations and exposing your -
self to feared sensations repeatedly, you will discover whether your beliefs about social
and performance situations are true or false.
Why Exposure May Not Have Worked in the Past
People who are about to begin exposure-based treatments often wonder why they
should expect exposure to work now if it hasn’t worked in the past. In all likelihood,
you’ve already been exposed to anxiety-provoking social situations from time to time
and, in many cases, your fear has probably not decreased. In fact, your anxiety may have
increased with repeated exposures. Given such previous experiences with exposure, you
may be skeptical about whether simply exposing yourself again to feared social situations
will lead to a decrease in your fear.
It’s important to acknowledge that exposure is not effective under all circumstances.
For example, unpredictable exposure can lead to an increase in fear, particularly if it
involves a negative event or consequence. Imagine this situation: You are afraid of dogs
and a dog unexpectedly runs out from behind a tree and starts growling at you. That
kind of exposure would only make your fear worse. On the other hand, if you are | shyness_social.pdf |
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152 gradually exposed to your neighbor’s friendly dog, at your own pace, your fear of dogs
might decrease.
In everyday life, exposure to feared situations is often unpredictable. In addition,
such everyday exposures tend to be brief and infrequent. All of these factors make
exposure in everyday life less likely to lead to a decrease in fear, compared with the type
of exposure that is used in cognitive-behavioral therapy. A summary of the main differ -
ences between the type of exposure you may have experienced in the past (previous
exposure) and the type that has been shown as useful for helping people overcome fear
(therapeutic exposure) appears below.
Typical Previous Exposures Typical Therapeutic Exposures
These are often unpredictable and
uncontrollable (e.g., you “end up” in the
middle of an unexpected conversation;
you are “forced” to go to a party that
you would rather not attend).These are predictable and under your control
(e.g., you make a decision to enter an
anxiety-provoking situation specifically
so that you can learn to be more
comfortable in the situation).
These have a brief duration (e.g., you get
into the situation, feel anxious, then
leave. This teaches you that when you
are in the situation you feel frightened,
but when you leave you feel better).These are prolonged (e.g., you decide to
stay in a situation until the anxiety comes
down on its own or until you learn that
your feared consequence doesn’t occur.
Here, you learn that you can be in the
situation, nothing bad happens, and your
anxiety eventually subsides). | shyness_social.pdf |
10b07ecbd5a8-1 | situation, nothing bad happens, and your
anxiety eventually subsides).
These are infrequent (e.g., because you
usually avoid when anxious, you are
not in the feared situation very often.
Each time you are in the situation, it’s
like starting over).These are frequent (e.g., you practice your
exposures over and over again and close
together. The benefits of exposures start
to add up).
These usually involve anxious thinking
(e.g., “People think I’m an idiot,”
“People will think I’m incompetent
if they notice my shaky hands”).These include countering of your anxious
thoughts (e.g., you ask yourself questions
to counter or challenge the anxious
beliefs and predictions).
These include subtle ways of avoiding the
situation (e.g., by distracting yourself,
using alcohol, bringing someone with
you, sitting in a certain “safe” location).These do not include subtle avoidance strategies
(e.g., you make a decision to not use
these strategies so that you teach your -
self to master the situation on your own).
Adapted from Antony, M. M. and R. P. Swinson. 2000. Phobic Disorders and Panic in Adults: A Guide to Assessment
and Treatment . Washington, DC: American Psychological Association. Used with permission. | shyness_social.pdf |
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153OBSTACLES TO COMPLETING
EXPOSURE PRACTICES
There are many different reasons why people sometimes don’t follow through on expo -
sure practices. We suggest that you anticipate the possible obstacles in advance and try
to think of ways to overcome them. There are always going to be reasons not to practice.
To combat the excuses you will undoubtedly come up with, you will need to remind
yourself of your reasons to continue to practice despite lack of desire, lack of time, or
being overwhelmed with the idea of confronting situations that make you anxious and
uncomfortable. Here is a listing of some of the most common reasons why people pro -
crastinate when it comes to doing exposure exercises. We’ve also offered some possible
solutions to these problems.
Obstacle: My practices are never planned in enough detail, so I am not sure
exactly what I am supposed to do.
Solution: At the beginning of each week, plan your exposure practices thoroughly.
You should know exactly what you’re going to do, where you’re going to
do it, and when you’re going to practice (dates and times).
Obstacle: Although I have good intentions, my plans never seem to work out. For
example, when I plan to have lunch with a friend, I often find that my
friend isn’t available when I call.
Solutions: Make sure you make plans early. Leaving things for the last minute will
make it much more likely that your plans won’t work out.
Be sure to have a backup plan. For example, if you’re planning to have
lunch with a coworker, make sure you have an alternative second plan | shyness_social.pdf |
573bb8244c8d-1 | lunch with a coworker, make sure you have an alternative second plan
and, sometimes, even a third plan, just in case your friend isn’t available
for lunch.
Obstacle: I always forget to practice.
Solutions: Plan your practices the way you would any other activity in your day.
Set aside blocks of time to practice and record them in your appoint -
ment calendar just as you would for any other appointments, so you
don’t forget.
Set an alarm (e.g., on your wristwatch or a small clock) as a reminder
to practice.
Ask other people to remind you, if necessary.
Obstacle: The idea of doing therapeutic exposure work seems overwhelming. I am
just too scared. | shyness_social.pdf |
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154Solutions: Start with an easier practice. The activity that you choose should be
challenging but not completely overwhelming. If a particular task seems
impossible, start with an easier task that does seem possible.
Use the cognitive strategies discussed in chapter 6 to challenge your
anxious thoughts before entering a feared situation.
Obstacle: I’m too busy. There never seems to be enough time to do the work.
Solutions: Put aside small blocks of time to be used exclusively for your social
anxiety exposure practices. If time is reserved just for this purpose, you
will be less likely to feel as if your practices are getting in the way of
your other important activities. This is something you want to do for
yourself. If you really want to deal with your social anxiety, you know
you can find the small blocks of time to reserve for the practices. Think
of practice times as taking a class. You may not always want to go to a
class, but if you want to learn what is being taught there, you find the
time to go.
Choose practices that can be completed during the course of your
regular routine. For example, you need to eat every day—you might as
well eat some of your meals with other people instead of always eating
alone.
Set aside a large block of time (e.g., clear a week-long vacation from
work) and spend the whole time practicing exposure nonstop.
Obstacle: I am not convinced that exposure practices will be helpful.
Solutions: Begin with a smaller exposure practice in which you have little to lose,
but in which you can still test whether exposing yourself to the situation
leads to a decrease in your fear. | shyness_social.pdf |
08a1e00f4513-1 | leads to a decrease in your fear.
The belief that exposure won’t work is probably just an example of a
negative thought that isn’t necessarily true. Examine the validity of your
beliefs regarding exposure. For example, can you think of reasons why
exposure may not have worked in the past? After you finish reading this
chapter, you may have some new ideas about how to ensure that expo -
sure will be more likely to work now.
Obstacle: My feared situations are difficult to create. For example, I can’t think of
any places to practice public speaking.
Solutions: Chapter 8 contains a large number of possible situations in which to prac -
tice exposure. Reading chapter 8 should help you to generate ideas.
Talk to family members and friends. They may be able to help you to
come up with some ideas for practices. | shyness_social.pdf |
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155HOW TO CONDUCT EXPOSURE PRACTICES
This section provides suggestions for getting the most out of your exposure practices.
These include instructions for how to prepare for practices, suggestions to keep in mind
when planning practices, what to do during a particular practice, and what to do follow -
ing the practice. Some of the most important suggestions are summarized in a checklist
following this section.
Preparing for Exposure Practices
As much as possible, it’s important to plan your exposure practices in advance. As
discussed earlier, planning involves making decisions at the beginning of the week about
particular practices that you intend to try, as well as coming up with backup practices in
case your original plans don’t work out. It is very likely that planning will involve setting
aside specific times during which to practice. You should also have an idea of how a prac -
tice fits in with your short-term and long-term goals. For example, if your long-term goal
is to be able to give a presentation to a large group of coworkers, practicing speaking to
smaller groups may be an important step in your plan.
Before beginning any particular practice, we suggest that you make some very spe -
cific predictions about what might happen during the practice. Once you are aware of
your anxiety-provoking thoughts and predictions, use the cognitive strategies described
in chapter 6 to challenge your thoughts. Challenging your anxious thoughts before
entering into the situation will help you to manage your fear and discomfort.
Importance of Predictability and Control
As we discussed earlier, exposure works better if it is predictable and if you have a
sense of control over what’s happening in the situation. Therefore, it’s best to start with | shyness_social.pdf |
288278f1cc0f-1 | exposure practices in which you have a pretty good idea of what is likely to happen.
Some situations, however, are inherently unpredictable. For example, if you decide to
ask another person out on a date, it may be impossible to know how the other person
will respond. In these cases, you can make the situation somewhat more predictable by
considering in advance all of the possible outcomes that could occur. For example, the
person might accept your invitation, turn it down, or put off responding for the time
being (for example, by not returning your call or saying, “I’m not sure, let me get back to
you”). The person may be warm or may come across as cold or uninterested. By antici -
pating as many outcomes as possible (as well as how you might cope with each outcome),
you will be less likely to be surprised. | shyness_social.pdf |
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156Duration of Exposure
Exposure works better if it lasts long enough for you to learn that your feared
outcome doesn’t occur. We suggest that you try to stay in the situation for as long as
possible. For example, if you are at a party, try to stay for at least a couple of hours. If
you’re giving a presentation and have the option of making it longer, try to take advan -
tage of the opportunity to speak for a longer time. Ideally, you should stay in the situ -
ation until your anxiety decreases to a mild or moderate level. However, even if your
anxiety doesn’t decrease during a particular practice, exposure will still likely be helpful,
especially if you don’t leave the situation too quickly.
If you are practicing being in a situation that is naturally very brief (something like
asking a stranger for the time or directions), you can prolong the anxiety-provoking situ -
ation by repeating the exposure over and over for a longer period. For example, instead
of asking one person for information while walking through a shopping mall (“Where is
the food court?”), you can ask twenty or thirty different people for the same information
over the course of an hour or more. The chances are good that your fear will decrease
over time.
Frequency of Exposure
Exposure works better if practices are repeated close together. For example, giving a
speech once a week is more effective than giving a speech once a month. Daily speeches
will decrease your fear more effectively than once a week, even if the number of prac -
tices is the same. In other words, giving a presentation five days in a row will likely lead
to a greater decrease in fear than giving a presentation once per week for five consecu - | shyness_social.pdf |
a94dcab28d4e-1 | tive weeks. So, try to schedule practices as frequently as possible. We recommend that
you set aside at least an hour to practice exposure on most days. Once your fear has
begun to decrease considerably, it is a good idea to gradually spread out the practices
to every few weeks or even to every few months, depending on the situation and how
often it arises in your day-to-day life. Occasional practices will help to maintain the
improvements you have made in decreasing your fear.
Practice in a Variety of Situations
To some extent, working on decreasing your fear in a particular social or performance
situation will help you to feel more comfortable in other social situations as well. This
process is called generalization , and research has shown that generalization often occurs
as a result of exposure. For example, if you learn to feel comfortable asking questions
in class, some of that success may “spread,” or generalize, to other situations, making it
easier for you to speak up at meetings at work. However, generalization will not cause
your success to spread to every situation you fear. Therefore, to get the most out of | shyness_social.pdf |
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157exposure, it’s best to practice in a variety of different contexts, places, and situations.
For example, if you want to be more comfortable making small talk, we recommend that
you practice with your coworkers, family members, strangers in the elevator, at parties,
and in as many other situations as possible.
Choose Practices That Are Challenging but
Not Impossible
You may feel discouraged if while trying a particular practice, you become anxious
or uncomfortable. There is no need to feel discouraged. In fact, it is helpful for you to
feel some discomfort during exposure practices. That’s why you are doing the practices
in the first place. Over time, you will begin to feel less anxious. A successful practice is
one that you complete, regardless of how anxious you feel.
On the other hand, it’s not necessary to choose practices that are completely terrify -
ing or for which you find it impossible to stay in the situation. If a situation seems too
difficult, we encourage you to try something easier. But do try something.
Choose Practices with Minimal Risk
Choose practices in which the likely consequences are minimal, except for a period
of feeling anxious. For example, if you want to be more comfortable with the possibility
of seeming foolish or being the center of attention, there are lots of safe practices that
you can try (for example, walking around with your shirt inside out, telling the cashier
that you have forgotten your wallet when you reach the front of the grocery line). There
is no need to take unnecessary risks, such as telling your boss what a jerk he is or yelling
out a dirty joke at your best friend’s wedding. If you’re not sure about the realistic risks | shyness_social.pdf |
b17f763ee519-1 | associated with a particular practice, ask someone whose judgment you trust (perhaps a
friend or family member).
Measure Your Improvement
It will be helpful to assess your anxiety from time to time using the forms and sugges -
tions in chapter 3. Evaluating your improvement periodically will remind you of how far
you have come and will also let you know when it is time to move on to new situations.
Include a Helper or Coach
Consider including a friend, coworker, or therapist to act as a coach during exposure
practices. This individual can help you with role-play practices (for instance, a mock | shyness_social.pdf |
3caef2318aea-0 | The Shyness & Social Anxiety Workbook
158job interview, practicing making small talk) and can provide you with feedback follow -
ing your practices. If you choose to include a helper during some exposure exercises,
that person should be familiar with the basic principles of exposure. Either you should
instruct the person about what their role as helper or coach entails, or you should have
the person read the relevant sections of this book. In fact, some combination of both
approaches may work best. In addition, the person you choose to work with should be
supportive and unlikely to become frustrated if things don’t work out as planned.
Keep Your Expectations Realistic
Don’t expect your anxiety to change overnight. It will likely take weeks or months
for it to improve. Also, you won’t be able to follow your improvement like a straight line
on a graph. You may find that in some situations your anxiety decreases fairly quickly,
whereas in other situations success takes longer. Also, you may find that some exposure
practices don’t lead to any improvement in your fear. You may even have weeks during
which your fear and anxiety worsen. A good rule of thumb is to expect one step back
for every two or three steps forward.
Don’t Fight Your Feelings
For years, you have probably been trying to control your anxiety, to prevent it from
occurring, and to get rid of it as soon as possible—no matter what the cost. By now,
you have probably discovered that trying to control your emotions doesn’t work. In fact,
attempts to control your anxiety are likely to make it worse rather than better. Fighting
your fear is like lying in bed trying hard to fall asleep by a particular time, telling your - | shyness_social.pdf |
3caef2318aea-1 | self, “I must fall asleep!” Often, the more you try to sleep, the harder it becomes. In fact,
for some people who have trouble sleeping, trying to stay awake is a productive strategy.
As soon as they stop trying to sleep, they fall asleep quite quickly.
When you can allow yourself to become anxious without fighting the feelings, even -
tually you will become much more comfortable in social and performance situations.
This sounds contradictory, but it really works this way. Instead of fighting your feelings,
just let them happen. Instead of evaluating your experiences (for example, “sweating in
front of others is unacceptable”), accept them. When practicing exposure, you should
observe your responses and experiences without evaluating them. Your fear will likely
pass more quickly if you are not trying so hard to get rid of it. Remember, the worst
thing that can happen is that you will feel uncomfortable for a while. Being anxious is
not dangerous, and anxiety always passes.
As reviewed in chapter 4, variations of cognitive behavioral therapy have recently
been developed that emphasize the importance of accepting one’s experiences rather
than trying to change them. Examples include mindfulness meditation and a form of psy -
chotherapy called acceptance and commitment therapy (Hayes and Smith 2005). These | shyness_social.pdf |
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159treatments have been found to be effective for treating certain types of anxiety prob -
lems, as well as for preventing depression from returning in people who have recently
overcome an episode of depression (Eifert and Forsyth 2005; Orsillo and Roemer 2005;
Williams et al. 2007). Learning to accept your uncomfortable feelings rather than fight
them will ultimately help you to feel more comfortable in the situations you fear.
Eliminate Subtle Avoidance Behaviors
As discussed earlier in this chapter, it is important that you stop the subtle avoidance
strategies you use to feel safer in social and performance situations. For example, if you
tend to sit on your hands so people won’t notice them shaking, try letting your hands
show. If you avoid talking about yourself when conversing with others, purposely try to
talk about your own interests and opinions. For example, mention a book that you’ve
recently read or a movie that you’ve seen, and share your opinions. If it’s a best seller
or a big hit, and you liked it, try to convey your enthusiasm to the person with whom
you’re talking; if you didn’t like it, don’t hide your opinion. Express yourself and take a
chance on engaging in an exciting dialogue.
Eliminating safety behaviors such as overpreparing for presentations, drinking
alcohol at parties, and wearing makeup to hide blushing will help you to learn that social
situations can be managed, even without using these strategies and behaviors.
Ending a Practice and Moving On to the Next One
Ideally, an exposure practice should not end before your fear has decreased to a mild | shyness_social.pdf |
4559d45b6516-1 | Ideally, an exposure practice should not end before your fear has decreased to a mild
or moderate level (such as 20 to 40 on a 0- to 100-point scale). Sometimes, this will take
a few minutes; other times, it may take several hours. If possible, try to stay in the situa -
tion until you feel more comfortable. However, even if your fear doesn’t decrease within
a practice, you will still likely benefit from the practice over the long term.
In reality, you may not always have control over when an exposure practice ends. For
example, if you’re practicing eating lunch with coworkers during a half-hour lunch break,
you may not have the option of stretching the lunch into two hours just to give your
anxiety a chance to decrease. If the situation ends before your anxiety has decreased, try
to practice the same situation again as soon as possible. Continue to repeat the practice
until it becomes easier. At that point, you can move on to another practice.
Using Exposure Records and Diaries
To get the most out of your exposure practices, we suggest that you use the diaries
and forms provided in chapters 8 and 9 to monitor your progress. | shyness_social.pdf |
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160The Aftermath of Exposure: Processing What Happened
Chances are that you will feel good following your exposure practices. Although
you may be tired, you likely will also feel relieved to have completed the practice and
proud of your accomplishments. Nevertheless, some people tend to analyze their every
move and criticize their performances during the practice (for example, “People surely
noticed my anxiety,” “I came across like a bumbling idiot”). If you tend to dwell on what
happened during your practices, we suggest that you try to put a more positive spin on
the experience.
Remember that the main reason you are practicing exposure is to eventually feel
more comfortable in social and performance situations. However, for now, expect to
feel uncomfortable during practices. Expect that your performance won’t be perfect (in
fact, the goal isn’t perfection anyway). Rather than dwelling on what happened or didn’t
happen, try to use the cognitive techniques from chapter 6 to challenge your negative
thinking. Also, try to take something positive from the experience. Even if things didn’t
go the way you had hoped they would, you can still use the experience to plan future
practices and to generate ideas for what you might do differently the next time.
A WORD TO SIGNIFICANT OTHERS, FRIENDS,
AND FAMILY MEMBERS
If you are reading this book in order to help a loved one, here are a few suggestions to
keep in mind. First, your loved one must be on board with this treatment. Treatment is
not something that can be forced on someone who isn’t willing to make the necessary
changes. In addition, you should avoid the temptation to trick, force, bribe, or coerce | shyness_social.pdf |
639b3b573f01-1 | a person into doing exposure practices. In order to get the most out of treatment, it’s
important that the decision to do exposure comes from the individual.
Your role in exposure therapy is to help brainstorm possible exposure practices,
to provide support, to participate in exposure role-plays (for example, a simulated job
interview), and to be involved in actual exposure practices when you’re asked to do so.
For example, if your loved one fears attending parties, he may ask you to attend a party
with him. If your loved one fears eating in restaurants, she may ask you to join her for
a meal. In advance of any exposure practices, discuss with your loved one what he or
she would like you to do in the situation (for example, provide reassurance, provide
company, probe for anxiety-provoking thoughts, and so on).
SUMMARY OF EXPOSURE GUIDELINES
This chapter described a long list of guidelines for how to get the most out of your expo -
sure practices. Following is a list of the most important suggestions, in summary form. | shyness_social.pdf |
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161UÊPlan practices in advance. Set aside time to practice exposure.
UÊExposure practices should be predictable and under your control (particu -
larly early in treatment).
UÊExposure should be frequent (almost daily), especially at the start.
UÊExposure should be prolonged. Try to stay in the situation until your fear
has decreased.
UÊUse cognitive strategies to challenge anxious thoughts before entering the
situation.
UÊUse cognitive strategies to challenge anxious thoughts during the practice.
UÊUse cognitive strategies to challenge anxious thoughts after leaving the
situation.
UÊDon’t fight your anxious feelings in the situation. Just let the feelings
happen.
UÊEliminate subtle avoidance strategies like distraction, alcohol use, and over -
protective behaviors.
UÊPractice in a number of different situations.
UÊChoose practices in which the actual risk is minimal, especially at first.
UÊChoose practices that are challenging, but not impossible.
UÊComplete exposure records (see chapters 8 and 9) with each practice.
TROUBLESHOOTING
Problem: My fear does not decrease during my exposure practices.
Solutions: This is normal to some extent. Although anxiety and fear usually decrease
during the course of a particular exposure practice, most people experi -
ence occasional practices in which their anxiety doesn’t decrease. Here
are some suggestions for dealing with this situation.
Make sure that you are staying in the situation long enough. Sometimes
it can take several hours for a person’s fear to diminish.
Make sure that you are not using subtle avoidance strategies. The
normal pattern during exposure is for fear to increase and then gradu - | shyness_social.pdf |
acb0df79b55f-1 | normal pattern during exposure is for fear to increase and then gradu -
ally to decrease. Using subtle avoidance strategies such as distraction | shyness_social.pdf |
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162may cause the fear to go up and down repeatedly over the course of the
practice, because most people are not very good at distracting them -
selves for long periods.
Negative thinking can sometimes interfere with the effects of exposure.
If your fear does not decrease during a particular exposure practice,
challenge your anxious thoughts using the techniques described in
chapter 6.
If all else fails, just keep practicing. Sometimes it takes repeated expo -
sure practices before a person’s fear begins to lessen.
Problem: My fear returns between exposure practices.
Solution: This is normal for most people. With more and more practice, your
fear will decrease more quickly during practices and will not return as
intensely between them. One way of preventing your fear from return -
ing between exposures is to increase the frequency of your practices,
particularly early in treatment.
Problem: My physical symptoms (for instance, stuttering, shaking, sweating) are
very noticeable.
Solution: Remember that, despite how it seems to you, the chances are good that
your symptoms are not as noticeable to others as you think they are.
Furthermore, as your anxiety decreases, the intensity of these symp -
toms will likely decrease. If you are concerned about people noticing
your symptoms, use the cognitive techniques from chapter 6 to chal -
lenge your anxious thinking. Remember that there are lots of people
who blush, shake, or lose their train of thought and who couldn’t care
less about what other people think. The problem is not that you experi -
ence these symptoms, but rather your beliefs about the consequences
of having these symptoms.
Problem: I am just not good at (making small talk,
public speaking, and so on). | shyness_social.pdf |
59e34ba092f4-1 | public speaking, and so on).
Solution: Your social skills are likely much better than you think they are. As
discussed in earlier chapters, people who are socially anxious tend to be
overly critical of their social and performance skills. Nevertheless, there
may be ways in which certain skills can be improved. It is likely that
exposure alone will contribute to an improvement of your skills. For
example, practicing making small talk will help you to learn what works
during a casual conversation and what doesn’t. In addition, we suggest
that you read chapter 10, which includes specific strategies for improv -
ing social and communication skills. | shyness_social.pdf |
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163Problem: My fear is too high to benefit from exposure.
Solutions: Ideally, you should choose practices that arouse a fear level of 70 to
80 out of 100, although it is also okay if your fear reaches even higher
levels. One method for keeping your fear in check is to use the cog -
nitive strategies from chapter 6 to challenge your anxious thoughts
before entering the situation. At times, however, even using the cogni -
tive techniques beforehand won’t prevent your fear from becoming very
intense.
If you find that your fear is completely overwhelming, you have three
options. First, you can try to wait a while longer to see if your fear
decreases. Alternatively, you may consider taking a short break and
then trying the same exercise again. Finally, you can try switching to a
less difficult practice. Any of these approaches is usually fine. The main
point is not to give up completely.
Problem: The situations that I fear are very brief in duration, so there isn’t enough
time for my fear to decrease.
Solution: This issue was discussed earlier in the chapter, but it’s worth highlight -
ing again here. Ideally, if an exposure practice is brief, you should try
to find creative ways to lengthen the duration of the practice, if pos -
sible. For example, if you are fearful of chatting with the cashier at the
front of a supermarket line, try lining up repeatedly over the course of
an hour or two and buying only a few items at a time. This approach
will give you more opportunities to talk to the cashiers, compared with
paying for all your groceries at once. | shyness_social.pdf |
17a4ddcc2948-1 | paying for all your groceries at once.
Problem: I just had something terrible happen during an exposure practice (for
example, my boss criticized my presentation). How can I ever try expo -
sure again?
Solutions: Although rare, it is possible that an unexpected negative event will
occur during an exposure practice. For example, you could experience
a bad panic attack during a job interview, or you may be laughed at
during a presentation. If something bad does happen during an expo -
sure practice, it’s natural for some of your fear to return. It may be
helpful to “rethink” the meaning of the negative event using the cogni -
tive techniques described in chapter 6. In addition, we recommend that
you resume your exposure practices. If necessary, you can return to a
previous item in your hierarchy and work your way back to where you
were when the unfortunate incident took place. | shyness_social.pdf |
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164Problem: I don’t avoid the situation, and yet my fear persists.
Solutions: Although exposure usually leads to a decrease in fear, occasionally
people report having intense fear in social situations despite almost
never avoiding these situations. For example, a person may eat with
others on a regular basis but still get anxious in the situation. If you
continue to experience fear, despite never avoiding the feared situation,
you may find it difficult to come up with appropriate exposure exercises.
Here are three strategies to consider.
First, if you fear experiencing arousal symptoms while in social situa -
tions, try the interoceptive exposure exercises discussed in chapter 9.
Second, assess whether you are engaging in subtle avoidance strategies,
overprotective behaviors, alcohol or drug use, or other strategies that
may be undermining the effects of the exposure. If so, try to discontinue
these behaviors. Finally, a special effort should be used to identify and
challenge the anxious predictions and beliefs that continue to maintain
your fear (see chapter 6). | shyness_social.pdf |
44e746cfc162-0 | CHAPTER 8
Exposure to Social Situations
In chapter 7, we provided an overview of the basic principles underlying exposure-based
treatments for social anxiety. In this chapter, we’ll present additional information about
how to use these strategies to confront the social and performance situations that make
you anxious or uncomfortable. You should be very familiar with the material in chapter
7 before moving on to this chapter. As noted earlier, we suggest that you use the cogni -
tive strategies described in chapter 6 to combat anxious thinking before, during, and
after exposure practices. During practices, you should refrain from using subtle avoid -
ance techniques such as distraction, drugs or alcohol, and safety behaviors (for example,
eating in a dimly lit restaurant so people don’t notice your blushing). Finally, a reminder
that exposure works best when practices are:
UÊFrequent (daily, if possible)
UÊProlonged (until the anxiety decreases)
UÊPredictable and controllable
UÊPlanned in advance
UÊConducted in a variety of different situations
SITUATIONAL EXPOSURE PRACTICES
This section provides suggestions for exposure practices involving different types of
social and performance situations, including public speaking, making small talk, meeting
new friends and dating, situations involving conflict with others, being the center of | shyness_social.pdf |
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166attention, eating and drinking in public, writing in front of others, job interviews, being
in public, and talking to people in authority. In addition to the suggestions provided
here, there is space in each section for you to record additional ideas for practices that
might be relevant to your own social and performance anxiety.
At first, many of the items suggested in this section may seem overwhelming.
However, as suggested in chapter 7, you should begin with challenging but manageable
practices. Over time, you will become more comfortable and most likely you will be able
to try some of the more difficult practices. In addition, some of these practices may seem
very easy to you. If you have no trouble with a particular type of social or performance
situation, there is no need to practice confronting it. Instead, focus on the situations that
are anxiety-provoking for you.
Practices Involving Public Speaking
To overcome a fear of speaking in front of others, it is helpful to take advantage of
opportunities that come up during the course of your job or other activities in your day-
to-day life. If public speaking opportunities don’t normally arise in your life, there are
many ways of creating these situations. Some of these include the following:
UÊSpeak up in meetings at work . For example, share your opinions about
issues being discussed. Ask and answer questions. If the opportunity to
make a brief presentation arises, take advantage of it.
UÊOffer to give a presentation at work or in another situation . For example,
if you belong to a book club or reading group, offer to present a summary
of the book that your group is reading. If you have some special expertise, | shyness_social.pdf |
19ef2ba3cc08-1 | of the book that your group is reading. If you have some special expertise,
offer to share it with your coworkers, colleagues, or friends by giving a
formal presentation.
UÊGo to a public lecture and ask questions . Public lectures are often adver -
tised in the newspaper, on the Internet, on the radio, or on television (for
example, on your local cable access channel). Also, check out advertisements
on community bulletin boards and posters at the library, supermarket, local
colleges, or other public places.
UÊTake a course at a college, university, or any school that offers adult
education courses . Try to choose courses that provide the opportunity to
give presentations. If these are not available, make a point of asking ques -
tions several times during each class. If you are unable to enroll in a course,
another option is to simply audit or sit in on a large class at a local univer -
sity. Professors will sometimes give guests permission to observe a class
without formally enrolling. Often, undergraduate classes contain hundreds
of students, so no one would notice an extra person in the room. Auditing | shyness_social.pdf |
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167a large class will save you from having to pay registration fees while still
providing you with an opportunity to ask questions in public.
UÊMake an impromptu speech or toast at a wedding, party, group dinner,
or other social gathering . If you are invited to a party or are planning to
have a party of your own, offer to make a short speech in front of the other
guests.
UÊTake a public speaking course . There are numerous companies that offer
public speaking courses (especially for businesspeople). These classes are
sometimes expensive, but it may be worth finding out more about the avail -
able options (perhaps your workplace would help to cover the costs). Check
the Internet or your local Yellow Pages to learn about courses. There are
many options available, including, for example, courses by Dale Carnegie
Training (www.dalecarnegie.com) and The Leader’s Institute (www.leaders
institute.com).
UÊJoin Toastmasters International . Toastmasters is an organization that holds
meetings for individuals who are interested in learning to speak more effec -
tively in front of others. They have more than 11,000 clubs located in ninety
countries around the world. Typically, groups include about twenty indi -
viduals who meet for one to two hours each week. Annual membership is
inexpensive. For more information, visit www.toastmasters.org.
UÊTake a drama or music class . Taking a theater, drama, or music class will
provide you with opportunities to perform in front of others. Classes may
be available at local high schools or colleges, professional theater or music
schools, the YMCA, or through other agencies. | shyness_social.pdf |
f5cc0263d4ad-1 | schools, the YMCA, or through other agencies.
UÊGive a lecture at a local elementary school, high school, or college about
your work . Sometimes schools will hold career days through which students
have opportunities to learn about particular jobs or careers. Additionally,
teachers sometimes invite guests to speak to their classes about particu -
lar types of careers or jobs. Call a local school principal to find out about
opportunities in your neighborhood school. Or, if you have a child in school,
you may have the opportunity to speak to his or her class about what you
do at work.
UÊRead a passage in front of others . For some people, reading a newspaper
article or a passage from a book in front of a few family members may
be anxiety provoking. For others, it may be important to try something
more challenging, such as reading an introduction for a guest speaker who
is about to give a presentation at your workplace. | shyness_social.pdf |
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168Now, can you think of other possible practices that involve public speaking? If so,
record them in the space below:
Other Practices
Practices Involving Making Small Talk, Casual
Conversation, and Informal Socializing
Casual conversation and small talk can take place anywhere. The list below provides
a few examples of situations where you might have the opportunity to practice these
skills. In addition to planning several large practices per week, you should try to engage
in several mini-practices throughout the day.
UÊHave friends over for a get-together . For example, invite several cowork -
ers over for dinner or to watch a movie or sports event on TV. Or, have a
birthday party for a friend or family member. Make sure that you interact
with your guests! Don’t come up with excuses to avoid them (like serving
food and drinks to the exclusion of conversation, cleaning up, or washing
the dishes).
UÊSpeak to strangers on elevators, while waiting in lines, at bus stops, or
at other public locations . With repeated practice, making small talk will
become easier. Prolonged exposure works best, so try to talk to many dif -
ferent people over the course of an hour or two to get the most benefit.
Smile, say hello, and use humor, if appropriate. Although you should be
prepared for some people to react negatively (remember, other people may
also be shy or they may be uninterested in making small talk), most people
will probably react positively.
UÊAsk for directions or for the time . Walk up to a stranger in a mall or store
and ask what time it is. Or, ask how to find a particular location. As men - | shyness_social.pdf |
ff8479d4fbd7-1 | tioned earlier, prolonged exposure works best, so try to do this repeatedly
over an hour or two or until your anxiety decreases.
UÊTalk to coworkers or classmates . Try arriving at school or work a bit early
so that you will have the opportunity to chat with others. Make a point of
saying hello to your coworkers or classmates during breaks. Simple ques -
tions such as, “How was your weekend?” are often a great way to get a
conversation started. | shyness_social.pdf |
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169UÊTalk to dog owners who are walking their dogs . Dog owners often love to
talk about their dogs. If you have a dog, try going for walks in areas where
other people walk their pets. Make comments or ask questions about other
people’s dogs (for example, “Nice dog” or “What kind of dog is that?”). If
you return to the same routes frequently, you will likely see the same people
over and over again. You may even make some new friends.
UÊTalk to cashiers or other staff personnel in stores . For example, comment
on the weather, ask for advice or information (“Does this shirt go with these
pants?”), or special order a book or CD.
UÊGive or receive compliments . Offer someone else a compliment. For
example, tell a coworker that you like her sweater or new haircut, tell an
artist that you like his work, or compliment a waiter on the quality of your
food. If you are uncomfortable receiving compliments, just say “Thank you”
when someone praises you. Don’t discount the praise by telling the person
all the reasons why you don’t deserve it.
UÊExpress a controversial opinion . If you have a controversial opinion about
some issue, express it, particularly in situations where the consequences are
likely to be minimal. For example, if you didn’t like a movie that someone
else is raving about, let them know what you didn’t like about the film. If
you disagree with someone else’s political views, explain your perspective
on the issue. Try not to put down the other person or to discount that
person’s views when you are expressing your own opinions. Differing views | shyness_social.pdf |