In a cognitive therapy workshop I once attended, Dr. David Burns, author of the classic, The Feeling Good Handbook, described an exposure session he’d had with a patient he was treating for social anxiety.
They’d walked from his office at the University of Pennsylvania to the food trucks in front of the quad and plopped themselves down on the sidewalk, lying with arms outstretched and eyes closed in the middle of the throngs queuing up to buy lunch.
Such an act of brazen disregard for social convention would be very hard to execute—and not just for the person being treated. As much as I admire Dr. Burns’ chutzpah and creative flair, I could never emulate it.
The closest I’ve come to assisting with an exposure that posed the risk of police intervention occurred shortly after 9/11, when I accompanied a patient with a pigeon phobia to several places in DC where the birds like to roost. They particularly favor the roof of the Air and Space Museum on the National Mall, and thus we ended up there, staring and pointing skyward for long enough to arouse suspicion. Judging from how the guards were eyeing us, I’m guessing we looked liked snipers scoping out sight lines to the Capitol.
A good exposure exercise gets at the heart of a person’s fear. While the situations will vary for different individuals, the core worry in social anxiety disorder, regardless of the circumstances triggering it, is of being scrutinized unfavorably by others and feeling embarrassed or humiliated.
Creating a public spectacle would be a very advanced exposure skill, and I wouldn’t recommend trying it on your own. But there are many less dramatic ways to challenge social anxiety in the comfort and privacy of your own home.
I’ve compiled a few examples from my clinical files. Hats off to the brave patients who came up with these ideas and were actually willing to try them!
- Friend a casual acquaintance on Facebook
- Accept a friend request from someone you don’t know well
- Email a professor with a question about an assignment
- “Like” a controversial topic on Facebook
- Send an email without proofreading it
- Send an email with an intentional misspelling or grammatical error
- Post a comment anonymously
- Post a comment using your real first name
Work your way through these exposures and you may, in time, find yourself standing to the left on a Metro escalator or, better yet, lying down on the platform during rush hour. Just don’t ask me to join you.
