Managing physical symptoms
Physical symptoms of social anxiety, such as rapid breathing, muscle tension, and palpitating heart, can be managed through several relaxation strategies, which include:
Controlled Breathing
When we are anxious, our breathing rate becomes rapid and shallow. This change in breathing pattern can make us feel faint and lightheaded; therefore, turning our attention to controlling our breathing can help alleviate feelings of anxiety throughout the event.
Progressive Muscle Relaxation
This strategy involves systematically tensing and relaxing muscles throughout the body to help alleviate muscle tension caused by anxiety.
Creating an Exposure Stepladder
We are instinctually inclined to avoid events which trigger anxiety and make us feel threatened. However, when we avoid these situations, we miss the opportunity to test whether our negative predications are actually true. While avoidance may offer short-term relief, it increases anxiety over time and makes facing similar situations in the future even more difficult.
When avoidance isn’t possible, people often turn to safety behaviors, actions aimed at reducing anxiety in the moment. For example, a socially anxious person might choose to sit in the back corner of a classroom to feel less visible. While this might ease anxiety temporarily, relying on safety behaviours prevents long-term recovery. Especially when those behaviours are suddenly unavailable.
What is Exposure Therapy?
Avoidance and safety behaviours can be reduced through exposure therapy, which involves:
- Identifying situations that cause anxiety and are usually avoided
- Ranking these situations from least to most anxiety-provoking
- Gradually confronting these situations over time
Research shows that with each exposure, individuals learn the following
- Anxiety decreases over time
- Initial anxiety reduces with repeated exposures
- Negative predictions rarely come true and when they do, the outcomes are usually not as bad as expected
How to Create an Exposure Stepladder
If you do not have access to a therapist, you can try implementing components of exposure therapy on yourself by creating an Exposure Stepladder.
Step 1: Identify your main goal
Start by clearly defining what you’d like to be able to do that currently feels too overwhelming.
Example: “I want to confidently attend social events and talk to new people.”
Step 2: List situations you typically avoid
Think of situations or behaviours you tend to avoid due to social anxiety. Examples include:
- Avoiding events with large groups
- Calling in sick to work when you are not ill
- Cancelling plans at the last minute
- Leaving events early
- Avoiding saying “goodbye”
- Steering clear of confident or authoritative people
- Pretending not to see someone you know
- Avoiding public activities like eating, writing, or using restrooms
- Not speaking up or sharing your opinions
- Waiting for others to initiate conversation
Step 3: Rank each situation by anxiety level
Give each situation a rating from 0 (no anxiety) to 100 (extreme anxiety).
Step 4: Start exposure gradually
Begin with the least anxiety-provoking task and aim to expose yourself to it 2 - 3 times per week until it no longer causes significant anxiety. Then, move up the ladder. Before each exposure, write down your predicted outcome. Afterward note what actually happened. This helps you challenge your negative beliefs and track your progress.
Example of an Exposure Stepladder:
Changing Unhelpful Thinking Styles
Unhelpful thinking styles, also known as cognitive distortions, can increase anxiety before, during and after social events. These distorted thoughts often occur automatically, without our conscious awareness, which is why it’s important to learn how to recognise them and replace them with more balanced, realistic alternatives.
Examples of unhelpful thinking styles include:
By monitoring when these thoughts occur and how often, you will be able to manage and challenge them more effectively as they occur. Thought challenging is comprised of three steps:
Step 1: Identify the thought
Use the ABC Model to break down your thought process. This method reminds us that it’s not the situation itself that causes emotional distress, but it is our interpretation of it. For example:
Step 2: Challenge the thought
Use thought-challenging questions:
- What evidence do I have for this thought?
- What is the evidence that this thought is untrue?
- What types of unhelpful thinking styles am I having?
- What are some alternative explanations?
- What would I say to a friend if they told me they were having the same worries?
- What's the worst that can happen and will it be as bad as I think it will be?
- If the worst does happen, what can I do to cope with it?
- If something bad does happen, will it still matter in a week/month/year?
Suggested structure:
Step 3: Replace with a realistic thought
After you challenge the distorted thought, write a more balanced interpretation of the situation. For example, you could replace the thought ‘everyone was noticing how much I was sweating’ with ‘everyone looked interested in my presentation.’
