Gradual exposure to feared social situations

Gradual exposure is a fundamental and highly effective therapeutic technique in the treatment of Social Anxiety Disorder.

It consists of the person systematically and progressively facing those social situations that they fear and avoid, with the objective of reducing anxiety and disconfirming negative beliefs about the evaluation of others.

Rationale. Breaking the Cycle of Social Avoidance

Social anxiety is maintained and aggravated by avoidance of the feared social situations.

Although avoidance provides temporary relief, it prevents the person from learning that their fears of negative evaluation are often exaggerated or that they can manage anxiety in those contexts.

Exposure seeks to break this cycle.

By confronting the feared situations, the person has the opportunity to:

• Habituate to the anxiety: Experience that anxiety, although intense at first, tends to decrease with prolonged and repeated exposure.

• Disconfirm catastrophic beliefs: Experience that the feared consequences (being humiliated, rejected, judged harshly) do not occur or are much less likely or severe than anticipated.

• Develop Social Skills: Exposure provides opportunities to practice and improve interaction skills.

• Increase Self-Efficacy: Each successful exposure increases confidence in one's ability to handle social situations.

Creating a Social Exposure Hierarchy

The process begins by creating a hierarchy of feared social situations, ordered from least to most anxiety-provoking (using the SUDS scale).

For example, the hierarchy might include items such as: asking a stranger the time, starting a brief conversation with a coworker, giving an opinion in a small meeting, attending a party, or giving a public presentation.

Implementing Exposure

Begin with situations in the hierarchy that generate low to moderate anxiety.

The individual exposes th