What Is Exposure Therapy & Why Is It Better For Social Anxiety Than Hiding Behind a Mask of Hair?

What Is Exposure Therapy & Why Is It Better For Social Anxiety Than Hiding Behind a Mask of Hair?

In a nutshell, the rationale behind exposure therapy is “short-term pain, long-term gain.”

It is meant to have the opposite effect of avoidance, which provides short-term gain but long-term pain by reinforcing anxious thinking patterns.

Fear is in the unknown

There could be ANYTHING down there. Werewolves, vampires, HUMANS.
Photo by Lucas Pezeta from Pexels

Think of it like watching a scary movie over and over. The movie gets less scary the more you watch it. But why does it get less scary?

  1. You’ve watched it before, so you know what’s coming.
  2. You know you’ve gotten through it before, so you have more confidence about your chance of making it through this time.
  3. You get to start noticing things you couldn’t notice when you were too scared and hyper-alert, and that opens you up to new and fascinating observations.

Fear is also in the memory of the unknown

By which I mean, I find it scarier to think back on a scary movie than to actually re-watch the thing.

Avoiding anxiety triggers gives them power. Facing them takes that power back.

(even though it might feel like
teeth-gritting,
butt-clenching,
vomit-tempting
mortification in the moment)

(Para)sympathy for the devil

In my CBT program, our group leaders told us that our bodies can only sustain a high level of anxiety for so long until our parasympathetic system kicks in and brings down our anxiety naturally. If you flee the situation too soon, you’ll never get to that lower-anxiety place.

Basically, if you’re willing to have a standoff with your anxiety, it will eventually fall asleep, unlike the kindergartner who tries to engage me in deep, convoluted conversation at bedtime every night.

But what do you actually DO for exposure activities?

Here are some examples we were encouraged to consider:

  • Make a telephone call
  • Read in front of others
  • Refuse an unreasonable request
  • Offer an opinion that is different from someone else’s
  • Buy one Timbit from Tim Horton’s
  • Ask for the time in a location where the clock is clearly visible
  • Buy, and five minutes later, return, the same book
  • Engage a stranger in conversation while trying to be as boring as possible
  • Order something that is clearly not on the menu, like pizza at a coffeeshop
  • Intentionally make a grammatical mistake online

Just looking at this list makes me a little anxious. (Sadly, just looking at the list probably doesn’t count as exposure therapy.)

Hospital parades and other shenanigans

Wherein tail feathers are shaken.
Photo by Pixabay from Pexels

I did many of the items on the list during therapy, and since.

One notable activity that’s not on the list was the day our group leaders presented us with a trunk full of ridiculous costumes and announced we were going to get dressed up and do a parade through the whole hospital, each taking 2 turns as leader of the crazy-parade.

It was a fuchsia feather boa and garish CANADA DAY headband for me, by the way.

No, I don’t have photos.

We did a bunch of other silly stuff too. But I shall regale you with those tales another day.

Trite and true

In closing, I will say that two cliches are certainly true for anxiety and exposure therapy:

  1. You can’t have courage without fear.
  2. Sometimes the only way out is through.
Or you could make yourself a hair-shield like I attempted to do in summer 2018, but your mileage may vary on this strategy.

Peaceful Jaws of Avoidable Death (Countering Cognitive Distortions)

Story time

So I’m working at Chapters (Indigo) right now, and when I first got here I couldn’t figure out how to access the laptop outlets under the big work table. I fiddled a bit, but then couldn’t bring myself to ask anyone for help.

So then I went to the Starbucks side of the store hoping for a table with an outlet, but they were full, except for one table where a man was packing up his stuff. But I couldn’t bring myself to stand there waiting awkwardly.

So I did a lap, and lost the table to another woman. Curses.

Now. Normally at this point I would have abandoned my mission of working in public (exposure in its own right, and something I try to do regularly). But instead, I forced myself to go ask an employee for help with the original Chapters outlets.

He was very helpful and it was only slightly embarrassing when we got back to the table and the (same) people who were (still) there watched as the employee–a kind, older gentleman–crawled (stiffly) under the table to (easily) pop open the outlet.

And then another patron made a (non-mean) joke about the employee earning his pay today. And I laughed along graciously and airily and all “Hahaha! I’m a normal human and you’re so funny and this is so not awkward AT ALL hahahaha HAHAHAHAHA okay stop laughing now.”

Anyway I’m not doing this story justice but the point is that it was AWKWARD (for me) and also a moment of bravery, because I didn’t just go home.

And now!

My last post talked about cognitive distortions, or “wonky thinking.” Check it out here: Bloodthirsty Jaws of Inescapable Death.

Last week’s post (clickable)

Based on one of your questions, I decided to do a follow-up post on how to actually challenge, or counter, those anxious thoughts.  

Countering a distortion involves asking healthier, more realistic questions to help pull you away from the brain bully’s toxic thought-vortex.

Using the same examples from my last post, here is how I would counter each distortion.

Countering cognitive distortions

Probability overestimation:

  • What it sounds like: This is for sure going to go downhill fast and end horribly.
  • How to counter it: What are other possible ways this could go? Is the Worst-Case Scenario the only or most likely outcome here?

Catastrophizing:

  • What it sounds like: If a kind-of-bad thing happens, then an even worse thing will happen, and then THE WORST will happen, and it will basically result in a zombie apocalypse.
  • How to counter it: If my worst-case scenario does come true, how bad would it *actually* be? A year from now, looking back, will I still think it’s earth-ending? [barring actual zombie apocalypse]
Rubber ducky who’s seen too much.
Photo by Tinyography from Pexels

Mind reading:

  • What it sounds like: I know what you’re thinking about me, and it’s bad.
  • How to counter it: Do I truly know what they are thinking? What ELSE might they be thinking? [there’s a very good chance they are thinking about their grocery list]

Fortune telling:

  • What it sounds like: This is going to end badly. I just know it.
  • How to counter it: Am I jumping to conclusions? Can I know FOR SURE what the future will bring?

Personalization:

  • What it sounds like: Whatever it is, whenever it happened, if it was bad, it was my fault, and I’m so, so sorry.
  • How to counter it: What other factors might be at play here? Does there HAVE to be someone to blame? Am I taking more than my fair share of the responsibility pie?
This girl is consuming all the responsibility fruit loops. Don’t be this girl.
Photo by Criativithy from Pexels

Minimizing the positives:

  • What it sounds like: You’re only calling me strong because [you don’t know me that well/I’m medicated/you’re trying to make me feel better].
  • How to counter it: Am I maybe, just maybe, focusing on my weaknesses and forgetting my strengths?

Discounting coping skills:

  • What it sounds like: If something bad or hard happens (it will), I won’t be able to handle it.
  • How to counter it: Am I forgetting similar situations that I handled well, or at least coped with and got through?

Should statements:

  • What it sounds like: I should be better at this. I shouldn’t need so much help or time. I should never be a bother to anyone.
  • How to counter it: Would I hold a friend or relative to the same standards?

All-or-nothing/black-and-white thinking:

  • What it sounds like: If I don’t get a new personal best on deadlifts, everyone will think I slacked on training and it will just prove to them that I am lazy and undisciplined.
  • How to counter it: Is there an in-between or grey area I’m ignoring? Can there not be reason for pride even if I don’t live the heaviest weight of my life today?
You must be THIS HAPPY ALL THE TIME or it doesn’t count.
[This is wrong. You can be half this happy or any amount of happy and it still counts.]
Photo by Jill Wellington from Pexels

Selective attention and memory:

  • What it sounds like: That one temper tantrum this morning means that my kids are miserable with me as a mother and I am not doing a good enough job.
  • How to counter it: Are there strengths in me I’m ignoring? Would an onlooker see it the same way?

Question!

I have several examples of real-life countering that I wrote down during therapy. One situation, for example, involves me mind-reading what our daycare supervisor thinks of me as a parent, and then notes on what questions I asked to talk myself through the anxiety.

Would you be interested in seeing a real-life example like this? If so, I can share it as my next post. 🙂

Closing thoughts

If you experience anxiety, remember that anxiety is a shared human experience. Some of us just experience a lot more of it and it interferes with our lives.

You didn’t choose to experience excessive anxiety. It’s not something you “deserve” because of some mistake you made or some personal failing.

This doggy would love you anyway. Tap into your inner unconditional love pup.

Mental health disorders are worthy of immense self-compassion.

We’re all just doing our own version of muddling through.

P.S. Here’s a list of just the countering questions! 😊

  • What are other possible ways this could go? Is the Worst-Case Scenario the only or most likely outcome here?
  • If my worst-case scenario does come true, how bad would it *actually* be? A year from now, looking back, will I still think it’s earth-ending?
  •  Do I truly know what they are thinking? What ELSE might they be thinking?
  • Am I jumping to conclusions? Can I know FOR SURE what the future will bring?
  • What other factors might be at play here? Does there HAVE to be someone to blame? Am I taking more than my fair share of the responsibility pie?
  • Am I maybe, just maybe, focusing on my weaknesses and forgetting my strengths?
  • Am I forgetting similar situations that I handled well, or at least coped with and got through?
  • Would I hold a friend or relative to the same standards?
  • Is there an in-between or grey area I’m ignoring? Can there not be reason for pride even if I don’t live the heaviest weight of my life today?
  • Are there strengths in me I’m ignoring? Would an onlooker see it the same way?

Bloodthirsty Jaws of Inescapable Death (aka “Cognitive Distortions” if you don’t share my flair for the melodramatic)

Today’s post was inspired by Caz’s informative series on the topic (cognitive distortions, not jaws of death). Check out her post on 10 thinking errors of depression that could be ruining your life. She has follow-up posts on the same topic as well!

Welcome to your brain gone wonky

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When I was doing my cognitive-behavioural therapy program for social anxiety, we learned about cognitive distortions, or, as one psychotherapist I used to see called them, “wonky thinking.”

One way of understanding cognitive distortions is to imagine looking at the world through a negative filter, where you see a warped version of reality that you interpret as true. It’s a biased thinking pattern that affects how you interpret yourself, other people, and the world around you.

Everyone has moments of wonky thinking. What is life if not a collection of subjective experiences that get all twirled together in our minds for better or worse, like salty, delicious mind pretzels? (…I’m hungry.)

But people with social anxiety disorder (SAD) can be practically drowning in distortions (me) and this affects their (our) well-being and mental health. And in the case of SAD, these distortions usually focus on our performance or what people think of us.

It’s like seeing yourself and the world through rose-tinted glasses, except less rose-tinted and more… judgy finger-pointing.

Good times.

Knowledge is power and so are giggles

Photo by Francesco De tommaso from Pexels

The point of learning about cognitive distortions is to begin recognizing them so that you can eventually challenge them.

There are plenty of Very Authoritative Articles providing clinical descriptions of cognitive distortions, and they are of course extremely valuable. But given that Very Authoritative Articles are generally not my jam (I prefer honey anyway) (with butter) (it’s heresy to have honey without butter), I decided to explain the distortions from the perspective of a person who often experiences them.

It is light-hearted (ish) because that’s how I like to approach things, but I don’t mean for it to sound like I’m taking serious matters lightly. I just need a little levity in my life when dealing with heavy topics like this.

The other note I’d like to make is that I wrote this list back when I was in therapy. I’ve come a long way since then in mastering my wonky thoughts.

Here is the list!

Cognitive distortions common to social anxiety

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  • Probability overestimation: A bad thing is likely to happen (except it’s not actually that likely).
  • Catastrophizing: If a bad thing happens, it will be catastrophic. One bad thing will unleash a domino effect where each domino is laced with horror and despair until every one of us is devoured by the bloodthirsty jaws of inescapable death (credit for that exquisite turn of phrase goes to Moana’s grandma in this opening scene.)
  • Mind reading: I know what you’re thinking about me, and it’s bad.
  • Fortune telling: I have an invisible crystal ball that is telling me that this is going to end badly. (There’s some overlap with many of these.)
  • Personalization: Whatever it is, whenever it happened, if it was bad, it was my fault.
  • Minimizing the positives: This is the “yeah, but” distortion. If you call me brave, I will say (in my mind), “Yeah, but you only think that because [you don’t know me that well/I’m medicated/you’re trying to make me feel better].”
  • Discounting coping skills: If something bad or hard happens (and it will), I won’t be able to handle it.
  • Should statements: One of our group therapists called this “shoulding all over yourself.” I should be better at this. I shouldn’t need so much help or time. I should never be a bother to anyone. [I am the queen of shoulding all over myself. I’m SO full of should, you don’t even know.] Applies to “must” and “must not” statements too.
  • All-or-nothing/black-and-white thinking: Letting the perfect be the enemy of the good. If I don’t hit a personal best on deadlifts today, everyone will think I slacked on training and it will just prove to them that I am lazy and undisciplined. 
  • Selective attention and memory: Noticing and remembering the negative more than the positive. That one temper tantrum this morning means that my kids are miserable with me as a mother and I am not doing a good enough job. (Never mind that our kids are happy, healthy, and loved.)

Such progress I’ve made, though

Photo by Singkham from Pexels

I used to think I really could read minds, and it never occurred to me that my interpretations might actually be wrong. That sounds arrogant until you consider that all my interpretations about myself were negative.

I also used to think that my social anxiety “quirks” made me unlovable and “bad.” But when I saw the others in my CBT group express those same thoughts and behaviours, it did not seem bad or ugly. It made me feel great empathy for them.

Over time, I’ve learned to extend that same empathy toward myself. And laugh a little at myself, too, but not meanly.

For the longest time, I had this weird feeling of not really “living” my life. I called it living a meta-life. I judged myself and imagined others judging me rather than actually being able to engage in the moment.

This sensation has become less intense over time, and I do think a lot of that is thanks to learning not to trust every knee-jerk thought and reaction I have.

Can I be a little sappy for a sec?

Photo by Frans Van Heerden from Pexels

I found this scrawled in my therapy notes, and thought I would share it because it reminds me of how much I was learning, even in those early stages of treatment:

“Black-and-white thinking is setting yourself up for failure. Learn to tolerate uncertainty and imperfection, and you’ll unlock a whole world of colour.”

Happy Friday you guys.

I really need a snack now.