How to Practice Exposure Therapy for Social Anxiety & Worksheets (PDF)

Social anxiety disorder is a mental health condition characterized by intense fear and avoidance of social situations, often driven by worries about judgment, embarrassment, or rejection. It can significantly interfere with daily functioning, relationships, and quality of life, and may require professional treatment to overcome.

Exposure therapy, a widely used psychological intervention, involves facing and gradually approaching the situations, places, or activities that trigger your anxiety. This type of therapy can be used for people of all ages, from children to older adults.

Its efficacy in treating social anxiety is rooted in the idea of systematically confronting fears, to help you create resilience, and overall reprogram any negative associations you have with your triggers. 

While you can engage in exposure therapy with a therapist, usually as part of cognitive behavioral therapy (CBT), it is possible to get some effective results from trying out exposure therapy techniques on your own.

Why avoidance can be a problem for social anxiety

Avoidance is a common coping mechanism for those with social anxiety, but it can end up intensifying anxiety in the long run.

While avoiding social situations may provide temporary relief, it reinforces the fear and can lead to increased scanning for danger. So, the more you avoid, the less opportunity you have to learn that social situations are not as threatening or scary as your mind and fear tell you. 

Therefore, this avoidance can lead to a cycle of increasing isolation, narrowing of your comfort zone, losing your self-confidence, and further elevating anxiety levels as a consequence.

Exposure therapy, a key component in treating social anxiety, works by gradually confronting these fears, and helping you build resilience and confidence in social situations.

Common social anxiety fears:

Many fears can stem from social anxiety. These can include but are not limited to fear of:

• being judged by others
• embarrassment or humiliation
• being negatively evaluated
• saying something inappropriate
• being the center of attention
• social exclusion
• public speaking
• making mistakes in front of others
• blushing or appearing visibly anxious
• initiating or maintaining conversations
• being perceived as boring or uninteresting
• conflict or confrontation

My story

Not too long ago, social anxiety had a tight grip on my life. Even the thought of a phone call could send me into panic. I was so paralyzed by the fear of judgment, and constant worries about what others might think of me. However, I was determined to break free of the cycle, and I did this by confronting my fears gradually. 

I started with simple steps like writing down exactly what I was going to say during a call and slowly worked my way up to chatting with colleagues and attending small gatherings. Step by step, my confidence grew and I pushed my comfort zone.

Today, I stand comfortably in front of large audiences, contribute to discussions and participate in panels. Therefore, if you are navigating a similar path, please use my story as an example of how self-exposure therapy truly works and how taking small, steady steps is perfectly fine. Remember, persistence is key, and each small triumph adds up to a bigger, more confident you!

Engaging in exposure therapy for social anxiety is not only possible but also empowering when done independently.

This step-by-step guide will provide some practical insights and exercises to help you gradually confront and overcome social fears.

Each step is designed to gently challenge your comfort zone, foster resilience, and provide a pathway to a more fulfilling social life. 

Identify Specific Social Fears 

Identifying specific social fears involves pinpointing the exact situations or scenarios that trigger your anxiety. It is about recognizing the specific thoughts, feelings, and bodily sensations that come up when you are in social situations. By identifying these fears, you can clarify what areas of social interactions cause the most distress. 

This awareness is important for developing targeted exposure exercises and addressing underlying cognitive distortions. Identifying such specific social fears will empower you to confront them directly, paving the way for effective coping strategies and eventual mastery over social anxiety.

For instance, if attending parties triggers anxiety, identify the underlying thoughts like, ‘I might embarrass myself’ or ‘Nobody will want to talk to me.’

Actionable steps:

• Mind Mapping: Use mind maps to visually identify situations causing anxiety. Break down broader fears into specific elements.
• Journal Reflection: Regularly journal your social experiences, noting instances of discomfort and anxiety.
• Therapeutic Guidance: Seek support from a mental health professional to identify underlying fears and gain insights.
• Online Forums: Engage with online communities discussing social anxiety to recognize shared fears and gain perspective.
• Discuss with Trusted Individuals: Talk to close friends or family about your social fears to get external insights.

Try completing our mindmap on identifying social fears:

My Social Fears Worksheet

Create a Hierarchy

Creating a hierarchy involves ranking social situations from least to most anxiety-provoking. This approach allows you to systematically tackle your fears, starting with less scary situations and gradually working up to more challenging ones. 

Breaking down social situations into smaller, manageable steps will help you prevent overwhelm and allow for a structured approach to exposure therapy. By systematically facing your fears in a controlled manner, you can desensitize yourself to anxiety triggers and build confidence in social settings!

For example, if making phone calls induces anxiety, rank scenarios like calling a friend first, then progress to work-related calls. Acknowledge thoughts like ‘I’ll sound stupid,’ and challenge them by focusing on the gradual nature of exposure.

Actionable steps:

• Fear Ranking: Assign a fear rating to each identified situation on a scale from 1 to 10.
• Consultation: Discuss your hierarchy with a mental health professional to refine and ensure a strategic approach.
• Personal Reflection: Consider the emotional impact of each fear, prioritizing those causing the most distress.
• Peer Support: Share your hierarchy with a trusted friend or support group for additional perspectives.
• Flexibility: Be open to adjusting the hierarchy as progress is made or unexpected challenges arise.

Try completing our exposure hierarchy worksheet:

Exposure Hierarchy Worksheet

Set Realistic Goals 

Setting realistic goals means choosing small, achievable steps to work on instead of overwhelming yourself with big challenges. This approach helps break down intimidating situations into manageable tasks, making progress more attainable. 

You build confidence and resilience over time by setting goals tailored to your abilities and gradually increasing their difficulty.

This is all about acknowledging where you are now and setting goals that push you slightly out of your comfort zone without overwhelming you. This helps to build momentum and keeps you motivated on your journey to overcoming social anxiety.

For example, if joining group conversations is a fear, set a goal to contribute one comment. Challenge thoughts like ‘They’ll judge me’ by focusing on the specific, attainable goal.

Actionable steps:

• SMART Goals: Make goals Specific, Measurable, Achievable, Relevant, and Time-bound.
• Consultation: Seek professional advice to establish realistic and tailored goals.
• Incremental Steps: Break larger goals into smaller, manageable steps for gradual progress.
• Self-Reflection: Assess your current capabilities and limitations when setting goals.
• Prioritize Safety: Ensure that goals align with your well-being and avoid unnecessary risk.

Try completing our SMART goals worksheet:

SMART Goals Worksheet

Reduce Safety Behaviors

Safety behaviors in social anxiety are actions that prevent feared outcomes in social situations, such as avoiding eye contact or rehearsing sentences before speaking.

Safety behaviors can help alleviate social anxiety in the short term but can maintain and exacerbate it in the long run for several reasons:

1. They prevent directly testing fears. By relying on safety behaviors, the socially anxious person never gets to truly test if their feared negative outcomes would actually occur. This prevents learning that the fears are exaggerated or inaccurate.
2. They can become self-fulfilling prophecies. The safety behaviors themselves, like staying quiet in meetings, can actually cause the feared outcomes like a boss getting frustrated.
3. If fears don’t come true, the safety behavior gets falsely credited. This increases dependence on the behaviors when, in reality, the feared outcome may not have occurred even without the safety behavior.
4. They increase self-focused attention. Monitoring one’s own thoughts and behaviors takes attention away from the social interaction at hand. This self-consciousness fuels more anxiety.

Dropping safety behaviors allows individuals to fully engage in social situations and test their negative predictions.

Over time, this can lead to increased social confidence as people learn they can handle social interactions without relying on safety aids. Reducing safety behaviors is an important target in cognitive-behavioral therapy for social anxiety.

For instance, someone with social anxiety may typically avoid eye contact during conversations as a safety behavior to reduce uncomfortable emotions.

By consciously making an effort to maintain eye contact during interactions, they can gradually reduce their reliance on this safety behavior and become more at ease during social interactions.

Actionable steps:

• Identify Safety Behaviors: Take note of behaviors you engage in to avoid feared outcomes in social situations e.g avoiding eye contact or rehearsing sentences before speaking.
• Challenge Negative Predictions: Question the validity of your negative predictions. Ask yourself if there is evidence to support these beliefs or if they are based on assumptions.
• Gradually Decrease Reliance: Reduce reliance on one safety behavior at a time. For example, if you typically avoid eye contact, challenge yourself to make brief eye contact with others during conversations.
• Test Your Fears: Experiment with facing situations without relying on safety behaviors. Start with less intimidating scenarios and gradually work your way up to more challenging ones.

Try completing our worksheet for reducing safety behaviors:

Reducing Safety Behaviors Worksheet

Visualization Techniques 

Visualization techniques mean imagining positive outcomes in social situations to feel less anxious and more confident. It is like mentally practicing how things can go well, which can help calm nerves and build self-belief. 

By picturing yourself handling social challenges successfully and repeating these mental rehearsals, you can gradually feel more comfortable in real-life situations. Incorporating this alongside other exposure therapy techniques can help you gradually overcome social anxiety and feel more confident in social situations.

For example, if public speaking induces anxiety, visualize yourself confidently addressing a small audience. Challenge negative thoughts like ‘I’ll forget my words’ by picturing a successful outcome.

It may also be helpful to visualize the worst possible scenario e.g., I will trip over and stumble over my words. Even if this happens, it can help you realize that you still survived this situation and overcome it. This will then boost your confidence when you actually come to such a situation.

Actionable steps:

• Positive Imagery: Envision successful social interactions with positive outcomes.
• Guided Imagery Resources: Use guided imagery resources available online or through mental health professionals.
• Daily Visualization Routine: Dedicate time each day to mentally rehearse positive/negative social scenarios.
• Recorded Affirmations: Create audio recordings of positive affirmations related to social confidence.
• Mindfulness Practices: Incorporate mindfulness techniques into visualization for increased focus and relaxation.

Implement Exposure Exercises (Confronting the things you avoid)

Implementing exposure exercises involves gradually exposing yourself to feared social situations in a controlled manner. Start with situations that provoke mild anxiety and gradually work your way up to more challenging scenarios. 

As you become more comfortable, you can gradually increase the complexity and intensity of the exposure exercises. Consistent practice is key to desensitizing yourself to anxiety-provoking situations and building confidence over time.

By systematically confronting your fears, you can retrain your brain’s response to social stimuli and reduce the intensity of anxious reactions!

For example, if your fear involves eating in public, begin by having a snack in a quiet park. Challenge thoughts like ‘People are watching me eat’ by staying focused on the gradual exposure process instead and switch to an alternate thought like “I am enjoying my meal and focusing on my own experience, just like everyone else around me.”

Actionable steps:

• Start Small: Begin with less intimidating situations to build confidence.
• Consistent Exposure: Regularly expose yourself to feared situations to diminish anxiety over time.
• Accompanied Exposure: Have a trusted friend accompany you during exposures for support (try not to rely on them too much for every situation though)
• Structured Approach: Follow a systematic approach, gradually increasing exposure difficulty.
• Celebrate Progress: Acknowledge and reward yourself after completing exposure tasks.

Try completing our exposure experiments worksheet:

Exposure Experiments Worksheet

Record and Evaluate Progress

Recording and evaluating progress involves keeping track of your exposure exercises, reflecting on your exposure experiences so far, and monitoring any changes in your anxiety levels over time. 

Start by documenting each exposure session, noting the specific social situation you faced, your initial anxiety level, and any challenging thoughts or feelings that arose. As you continue with your exposure exercises, regularly review your progress log to identify patterns and trends. 

Set aside regular time to review your progress log and consider how your anxiety levels have fluctuated throughout your exposure journey. Pay attention to any patterns or trends that emerge, and reflect on the strategies and techniques that have been most effective for you. At this stage, you can consider adjusting your approach if needed. 

Keeping these records serves as a tangible reminder of your accomplishments and can boost motivation during moments of doubt or setbacks.

Additionally, tracking your progress and rating your anxieties or worries before vs after provides valuable insight into your personal growth and can help you recognize the effectiveness of your efforts in overcoming social anxiety.

For instance, if attending social events induces anxiety, record specific thoughts like ‘I’ll be the odd one out’ and challenge them by noting positive interactions and connections made, like moments where you shared a laugh with someone or found common interests.  

Actionable steps:

• Journal Entries: Document thoughts, emotions, and observations after each exposure.
• Rating System: Use a numerical or color-coded system to quantify anxiety levels during exposures.
• Self-Assessment Questions: Try asking yourself things like “Was it as bad as I thought it would be?” and “How would you feel about doing it again?”
• Visual Logs: Create visual representations, such as graphs, to illustrate progress over time.
• Reflective Questions: Pose reflective questions in your journal to deepen understanding and awareness.
• Pattern Recognition: Identify recurring patterns in anxiety triggers or successful coping strategies.
• Professional Feedback: Seek feedback from a mental health professional to gain external insights.
• Adjustment Strategies: Modify exposure strategies based on identified challenges or areas of improvement.

Dealing with setbacks

Remaining flexible is crucial as you navigate your journey of overcoming social anxiety. Understand that progress may not always be linear, and there will be ups and downs along the way.

Stay open to adjusting your approach and trying new strategies as needed. If a particular exposure exercise feels too overwhelming, do not hesitate to scale it back or try a different approach. 

Additionally, flexibility means being kind and patient with yourself when setbacks occur. Instead of viewing them as failures, try to see them as opportunities for learning and growth.

By remaining flexible and adaptable, you can better navigate the challenges of social anxiety and continue moving forward on your path to recovery.

For example, if the original plan was to join a networking event but that felt too overwhelming, you can switch to joining an online discussion forum. This will allow you to still socialize while doing it at a comfortable pace. 

Actionable steps:

• Adaptability: Embrace flexibility in your exposure plan to accommodate unexpected challenges.
• Feedback Integration: Consider feedback from exposures, adjusting goals and strategies accordingly.
• Open Communication: Maintain open communication with a mental health professional, updating them on progress.
• Real-Time Adjustments: Be willing to modify exposure plans based on real-time anxiety levels or changing circumstances.
• Learn and Pivot: View unexpected challenges as opportunities to learn and refine your approach.

Try completing out worksheet on challenging unhelpful thoughts:

Challenging Unhelpful Thoughts Worksheet

Celebrate Achievements 

Celebrating your achievement of reducing avoidance and safety behaviors is an essential part of your journey toward overcoming social anxiety.

Take time to acknowledge and celebrate every small victory, whether it is successfully initiating a conversation with a stranger or attending a social event without feeling overwhelmed. 

Celebrating achievements can help reinforce positive behaviors and boost your confidence, making it easier to continue facing your fears.

Find meaningful ways to reward yourself for your progress, whether it is treating yourself to something special, sharing your accomplishments with a supportive friend or loved one, or simply taking a moment to appreciate how far you’ve come.

Remember that every step forward, no matter how small, is worth celebrating and deserving of recognition. By celebrating your achievements along the way, you can stay motivated and inspired to continue working towards your goals.

For example, if the fear is attending social gatherings, initiating conversations, or staying longer. Challenge thoughts like ‘I’ll ruin the event’ by recognizing your positive impact and the connections you have made e.g., ‘Although I was nervous, I am proud of myself for asking follow-up questions and carrying on the conversation.’.

Actionable steps:

• Reward System: Establish a reward system for reaching exposure milestones.
• Share Successes: Communicate achievements with supportive friends or family.
• Self-Acknowledgment: Practice self-compassion by acknowledging and celebrating your efforts.
• Creative Expressions: Use creative outlets, such as art or writing, to express and celebrate progress.
• Social Celebration: Plan a small social celebration after completing significant exposure goals.

Conclusion

In conclusion, overcoming social anxiety through exposure therapy is a journey that requires patience, persistence, and self-compassion. By gradually facing your fears, setting realistic goals, and tracking your progress, you can build confidence and reclaim control over your social life. 

Remember to celebrate even the smallest achievements and remain flexible in your approach. Seek support from trusted friends, family members, or mental health professionals when needed. With dedication and perseverance, you can overcome social anxiety and live a more fulfilling and connected life. You got this!

Try completing all of our exposure therapy for social anxiety worksheets below:

Exposure Therapy For Social Anxiety: All Worksheets (PDF)

References

Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. (2019). Exposure therapy for anxiety: Principles and practice. Guilford Publications.

Dixon, L. J., Kemp, J. J., Farrell, N. R., Blakey, S. M., & Deacon, B. J. (2015). Interoceptive exposure exercises for social anxiety. Journal of anxiety disorders, 33, 25-34.

Hopf, T., & Ayres, J. (1992). Coping with public speaking anxiety: An examination of various combinations of systematic desensitization, skills training, and visualization. Journal of Applied Communication Research, 20(2), 183-198.

O’Toole, M. S., Zachariae, R., & Mennin, D. S. (2017). Social anxiety and emotion regulation flexibility: Considering emotion intensity and type as contextual factors. Anxiety, Stress, & Coping, 30(6), 716-724.

Radtke, S. R., Strege, M. V., & Ollendick, T. H. (2020). Exposure therapy for children and adolescents with social anxiety disorder. In Exposure Therapy for children.

Reichenberger, J., & Blechert, J. (2018). Malaise with praise: A narrative review of 10 years of research on the concept of Fear of Positive Evaluation in social anxiety. Depression and anxiety, 35(12), 1228-1238.

Safren, S. A., Heimberg, R. G., Horner, K. J., Juster, H. R., Schneier, F. R., & Liebowitz, M. R. (1999). Factor structure of social fears: the Liebowitz Social Anxiety Scale. Journal of anxiety disorders, 13(3), 253-270.

Winton, E. C., Clark, D. M., & Edelmann, R. J. (1995). Social anxiety, fear of negative evaluation and the detection of negative emotion in others. Behaviour research and therapy, 33(2), 193-196.