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3 Exposure Therapy Tips to Deal With Social Anxiety

Updated: Nov 6, 2023


After being cooped up at home for years during the Covid-19 pandemic, many of us were feeling socially anxious for the first time ever. And that’s natural considering what we went through.





You know you have anxiety when…

  • You feel discomfort in social situations, or worry in anticipation of social situations

  • You tend to avoid social outings

  • Physical symptoms e.g racing heart, nausea, dizziness, sweating, feeling flushed in social situations


Why is social anxiety common post pandemic?

Research published in 2023 (Kindred, Bates) has shown the link between the pandemic and social anxiety. There are several explanations for this:

  1. Isolation and Loneliness: The lockdowns and social distancing measures, although necessary for public health, led to feelings of isolation and loneliness, which can be contributing factors to social anxiety.

  2. Fear of Contagion: The fear of contracting COVID-19 during social interactions could have exacerbated social anxiety symptoms.

  3. Disruption of Routine: The sudden and dramatic changes in daily life, including work, school, and social routines, can create stress and anxiety. For some individuals, this disruption can trigger or worsen social anxiety.

  4. Increased Use of Virtual Communication: With the rise of virtual interactions as a substitute for in-person socializing, some individuals with social anxiety might have experienced "Zoom fatigue" or felt anxious about constant video calls.

Zoom fatigue was an interesting phenomenon, researched by Jeremy Bailenson in 2020.

He talks about 4 ways in which this format of interaction needed adjusting to:

-Having to forcefully gaze into people’s eyes at close distance (vs. in an elevator where our eyes naturally gravitate towards the floor)

-Cognitive load: on Zoom calls we are actively both sending and receiving non-verbal signals in addition to the verbal signals. E.g. looking sideways may have a social implication, and our brains are constantly trying to decode all this information

-An all-day mirror: having to look at ourselves constantly throughout the day has been linked with increased self-evaluation and criticism

-Reduced mobility: in an in-person situation you are free to walk around, stretch etc. whereas people assume that listeners on a Zoom call are relatively immobile


What is exposure therapy for social anxiety?

There are many reasons why people were/ are socially anxious post pandemic, but it mostly boils down to this: we are/ were simply out of practice.

Exposure therapy is a form of cognitive-behavioral therapy that has been proven effective in treating social anxiety disorder (SAD). The main idea behind exposure therapy is to help individuals gradually face and overcome their fears in a controlled and safe environment. In the case of social anxiety, this means confronting social situations that trigger anxiety.

During exposure therapy for social anxiety, a therapist might:

  1. Start by helping the individual create a hierarchy of feared social situations, from least to most anxiety-provoking.

  2. Gradually expose the individual to these situations, starting with the least anxiety-provoking and working up to more challenging situations.

  3. Use a combination of in vivo exposure (real-life situations) and imaginal exposure (visualization or role-play).

  4. Provide feedback and support to help the individual develop more effective coping strategies.

The goal of exposure therapy is to help individuals develop a sense of mastery over their anxiety and learn that social situations are not as threatening as they might have believed.


3 strategies to deal with re-entry social anxiety: What can you do, starting today

Our brains modify with our environments (a phenomenon that is technically called neuroplasticity), and the road to recovery is often about giving ourselves more experience in social situations.

  • Notice & name the fear. By putting a label on it, we actually engage the more sophisticated "thinking" part of our brains, the pre-frontal cortex, rather than relying purely on the emotional part. This helps is feel more in charge.

  • Opposite action technique - instead of avoiding social situations, put on your best clothes and head out. Avoidance and anxiety are two sides of the same coin. The more we avoid a situation, the more scary we believe it is. When we give ourselves more experience in social situations, they start to feel less scary.

  • Think of social situations as an experiment: did your worst fears come true? Was it as bad as you expected? Behavioural experiments are a technique often used in therapy to help test our beliefs or expectations about ourselves and our abilities.

In conclusion

We are social beings, and our ancestors’ survival depended on their connection to others. It’s natural then, that what others’ think of us does matter to us. However, these thoughts can often get in the way of our lives, and stop us from pursuing the activities that build meaning. With a little help, it is possible to find our way back to our groups, communities and ourselves.


If you're new here, I'm Diya John, a counselor and psychotherapist with a Masters in Psychology and a Diploma in Counselling from Australia. I founded Therapy Garden to make evidence-based counseling more accessible to expatriates, immigrants and the international community. I am based in Tokyo, but I work with clients in different parts of the world via online therapy. You can book a free consultation or read more about my areas of specialisation and services.






References

  • Bailenson, J. N. (2021). Nonverbal overload: A theoretical argument for the causes of Zoom fatigue. Technology, Mind, and Behavior, 2(1).

  • Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, 395(10227), 912-920.

  • Feske, U., & Chambless, D. L. (1995). Cognitive behavioral versus exposure only treatment for social phobia: A meta-analysis. Behavior Therapy, 26(4), 695-720.

  • Fountoulakis, K. N., Karakatsoulis, G., & Abraham, S. (2022). The effect of the COVID-19 pandemic on global mental health. Molecular Psychiatry.

  • Heimberg, R. G. (2002). Cognitive-behavioral therapy for social anxiety disorder: current status and future directions. Biological Psychiatry, 51(1), 101-108.

  • Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368-376.

  • Vindegaard, N., & Benros, M. E. (2020). COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain, Behavior, and Immunity, 89, 531-542.

  • Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17(5), 1729.

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