My Issue with Exposure Therapy

One thing I’ve heard about dealing with Social Anxiety Disorder is the way exposure therapy is supposed to help me: by exposing myself to social situations enough, I’ll realize that I won’t die from being social, so it’s not that bad.

I have two issues with that.

  1. Just because it hasn’t happened yet, doesn’t mean it won’t; and
  2. Dying from it is obviously not what I’m afraid of.

Let’s start with #1.

Just because it hasn’t happened yet…

Imagine someone with a snake phobia. Now, in the (paraphrased) words of supercarlinbrothers, if you come home, enter your bedroom and there’s a poisonous snake on your bed, a normal reaction is to back out of the room real fast, close the door, and call for help. This is a natural fight-or-flight-response; it’s a fear response, but a perfect example of why fear can make sense.

If you have an actual phobia of finding a snake in your bed, however, you might not even open the door to your bedroom in the first place because there might be a snake on your bed. And that happens every day — because just because there wasn’t a snake there yesterday, and the day before that, doesn’t mean there won’t be one today, right?

Even worse; imagine you know that one day in your life, you will come home and find a poisonous snake in your bed. In that case, finding out that there is no snake on a particular day actually increases the chances of finding one there the next day, just like in a deck of cards, where sooner or later you will draw the 5 of diamonds and the less cards there are left, the more likely it will become.

Of course I don’t know that one day, terrible things will happen during a social interaction; and I’m aware of that. That’s why it’s called social anxiety disorder.

Dying from it is obviously not what I’m afraid of

…so what am I afraid of?

Sure, I’m afraid of ridicule. Doing something embarrassing. Great, you might think. Just get exposed enough to doing embarrassing things, and you’ll realize you won’t die from it.

The thing is, dying from it is still not what I’m afraid of. It’s the feelings it will give me. And not just the feelings ridicule would give me (which, I guess most people can agree, would suck), but the feelings certain social interactions give me.

Here we get into the territory of something called the Highly Sensitive Person, or HSP for short. I’ll give just one example. If I watch a TV show where something embarrassing is happening to someone, or is about to happen, I cringe inside and get the strong urge to change the channel. Because once the embarrassing thing happens, I feel embarrassed. That’s also the reason I can’t watch those funny TV shows where people fall off things. To me, it’s not funny, but just painful.

I wish I could explain it better, but basically that means that some social interactions feel painful or embarrassing to me even though there’s nothing to be embarrassed about. And it’s that feeling itself that I get afraid of, because it’s uncomfortable. I guess it exacerbates the feeling of anxiety I get in certain social situations.

As Barbara Markway Ph.D. points out:

3. Finally, for exposure to be effective, you should remain in the situation until your anxiety level drops. This is often difficult in the case of social anxiety. Think of all of the social situations that are brief by nature: a handshake, answering the phone, smiling at someone on the street, introducing yourself in a meeting…
There’s no way to prolong these situations so that your anxiety level can come down naturally.

And if the anxiety level doesn’t come down naturally, I remember the exposure as actually scary and feel validated in my belief that I should avoid these situations.