Behavior therapy for social anxiety disorder is very effective, but it is hard work. This list is a sample of what an exposure hierarchy may look like for someone getting treatment for social anxiety. The numbers are based on a scale from 1-10, 1 being "that would make me a tiny bit anxious" to 10 being "full blown panic." We work our way through.
  1. Making eye contact with a stranger I am passing on the street-1
    People with social anxiety may avoid deliberate eye contact. The idea is to do the opposite to overcome fear and apprehension.
  2. Calling a friend I haven't talked to in awhile-2
    Generally the socially anxious are not HUGE fans of talking on the phone. The piece about it having been awhile adds an element of difficulty as well.
  3. Asking someone on the street for uncomplicated directions-3
    Fear of inconveniencing others is real people. 😳
  4. Paying for $5 worth of groceries with change (no bills, just coin) with people waiting behind me-4
  5. Talking very loudly on my cell phone in a quiet public place, like a library-5
  6. Trying to use the restroom in a stall next to someone else-6
    When diagnosing social anxiety we often ask if public restrooms are commonly avoided
  7. Purposely asking a "dumb" question in a classroom full of people-7
    School can be challenging in many ways for someone with social phobia. Giving a presentation that requires speaking in front of a group of people is something that may be dreaded for months prior. Many people will drop classes entirely to avoid having to public speak.
  8. Attending a party and not knowing anyone there, or knowing very few people there- 8
    I am pretty sure this would make even the most outgoing person slightly anxious, but for those with severe Social Phobia this could feel nightmarish.
  9. Asking a stranger to borrow money-9
  10. Standing on a park bench in the middle of NYC and screaming something completely random at the top of my lungs-10
    I have actually done this with a client. It took several attempts before she was able to go through with it but once she did she found it kind of liberating.
  11. That wraps it up. Everyone's hierarchy will vary and may be in a different order but the point is to work through the entire thing. Usually we have several 1's, 2's etc in order to habituate (get used to, acclimate) to each area. This type of work should be done with the help of a trained Cognitive Behavioral Therapist (CBT).
  12. I know, it seems like systematic torture. But with the right support and a little bit of motivation even the most anxious can get through it! In my experience people with social anxiety are some of the loveliest, like-able people. My goal is to find them, and get them out of hiding. 🙈