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Disclaimer: My content is NOT a substitute for professional advice, diagnosis, or treatment. When in doubt, ask a therapist!
Alright, this is strange…
Research shows that exposure therapy is an effective social anxiety treatment. And, common sense checks out: the more you get exposed to something, the more you get used to it. Right?
So why wouldn’t exposure work then?
One obvious reason is inconsistent practice: you need to practice exposure — facing your social fears – a few times a week at least.
Here are other reasons why exposure isn’t effective:
It doesn’t address the root cause of social anxiety
Here’s what Larry A. Cohen, the co-founder of the National Social Anxiety Center, said:
“Why does social anxiety usually not habituate naturally despite daily exposure? The feared outcome (judgment) is usually invisible. Even if someone seems to react positively, it is easy to disqualify the positive: eg. “They’re just being nice.”
In other words, you can go through exposure therapy again and again, but if you haven’t learned anything new that challenges/disproves your core beliefs, you won’t make much progress.
It’s just like being a hamster…
(Here’s how to introduce new, helpful beliefs.)
It doesn’t help you learn from the experience
Repetition alone doesn’t lead to learning.
In the case of exposure therapy, repeated exposure isn’t helpful if it’s not helping you learn that your anxiety-driven assumptions are inaccurate.
Let me give you an example. Imagine that you run into a Pokemon monster every day. And you never learn that the monster is actually harmless. Result: scare of the day on repeat!
You’re relying on your safety behaviors
Safety behaviors are things you do/don’t do to avoid feeling anxious. For example, you might focus on asking the “right” questions or saying very little. And here’s the problem with that:
Rather than becoming confident in your ability to handle anxiety during exposure, you become confident in your safety behaviors instead!
(Learn more about safety behaviors here.)
To rely less on safety behaviors, here are two suggestions:
- Acknowledge the discomfort: Exposure therapy will trigger anxiety, and that’s OK — it’s part of the process. It’s like getting a vaccine: you will feel sick in the short term, but your body gets stronger in the long run.
- Be mindful of your anxious thoughts and emotions: When you’re unaware of your anxiety, it’s easy to slip into safety behaviors, rather than acting intentionally.
- Stay present: Try any of these mindfulness exercises to stay present despite anxiety.)
Your therapist is reluctant to use exposure
OK, let’s just say that you are aware of your core beliefs, safety behaviors, and whatever else you’re doing that’s making exposure therapy less effective.
There’s one more barrier to consider…
Your therapist.
Wait, what?
While exposure is endorsed by academic research, it’s rarely used by therapists. As researchers reported:
“Despite scientific recognition that exposure is critical to the success of CBT for anxiety, recent estimates suggest that only 10–30 percent of clinicians endorse using exposure therapy in routine clinical care…”
Why is there such a big gap between research and reality? It turns out that many therapists worry about the negative effects of exposure and/or dismiss exposure as ineffective.
(It’s telling when a therapist dubbed exposure as “The Cruelest Cure” in her NYT article.)
If you’re ready to try exposure therapy, reassure your therapist that you’re willing to practice exposure therapy despite the discomfort. And if you don’t have a therapist yet, find one who mentions exposure as part of their therapy toolkit.
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