Do you feel anxious in dating or social settings? If speaking to attractive strangers, trying to make new friends, or socializing at parties makes you feel uncomfortable, exposure therapy could help reduce or even eliminate your anxiety.
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Exposure therapy is a behavioral approach that involves gradual exposure to anxiety-provoking stimuli to help desensitize the brain. This allows individuals to face their fears in manageable doses, using their skills along the way, and over time, their brains stop associating socializing and dating with fear.
In fact, you’ve probably heard of exposure therapy before.
A (playful) example of exposure therapy
Sheena has a phobia of fluffy bunnies. She seeks help from a therapist who specializes in leporiphobia (yup, that’s the official term. You’re welcome).
The therapist teaches Sheena about exposure therapy and obtains her consent for this method. (Note that getting Sheena’s buy-in is incredibly important. Exposure therapy induces short-term discomfort in order to effect long-term anxiety relief; if you aren’t all-in on the process, you’ll likely give up as soon as you experience anxiety!)
Next, the therapist helps Sheena develop an exposure hierarchy (more on that below). They identify ways Sheena can progressively challenge herself to face her fear by exposing herself to the idea, image, or actuality of a fuzzy bunny.
Simply discussing future exposures spikes Sheena’s anxiety. This is good, her therapist explains – the exposures have begun! They continue to discuss potential future exposures to bunnies and utilize calming techniques until Sheena is only mildly anxious discussing the topic.
Ready for the next level of challenge, the therapist shows Sheena a picture of a fluffy bunny. Sheena’s anxiety raises to a 5/10. The therapist helps the woman use her new anxiety reduction tools to calm her nervous system, then they rinse and repeat.
Sheena looks at the picture of the bunny during and between sessions until her anxiety only reaches a 2/10.
The therapist then brings a stuffed fluffy bunny to session, which spikes Sheena’s anxiety to a 5/10. They alternate exposures to the stuffie with regulating, grounding practices until Sheena can tolerate holding the toy with only mild levels of anxiety.
The exposures continue in small steps until the woman can touch and hold a live rabbit with only mild levels of anxiety. Success!
How do you do exposure therapy?
To engage in exposure therapy, choose activities that raise your anxiety to a 30-50 on a scale of 0-100, 0 being “no anxiety” and 100 being “maximum anxiety.” Repeat each exposure as many times as necessary (interspersed with soothing practices) until your anxiety dips below 30. At that point, you can move on to more challenging exposures.
One of the best tools for designing a course of exposure therapy is the exposure hierarchy, which we’ll review in the next section.
Before that, let’s review another example of exposure therapy in order to identify some of the key principles of this treatment.
Let’s say your goal is to overcome your fear of asking out an attractive stranger, which raises your anxiety to 90 out of 100.
One baby step towards that goal might be to send a message to a match on an online dating app that makes a connection but doesn’t go so far as to request a date.
Let’s assume sending such messages increases your anxiety to 45. Remember that anxiety sweet spot that we mentioned before, i.e. between 30 and 50? When you find a challenge that increases your anxiety to that range, you’ve found the next step in your exposure therapy.
Your job is to engage in this exposure repeatedly until your nervous system stops associating it with danger. You’ll know it’s time to move on to the next exposure when your anxiety drops below 30 with the current exposure.
In this example, you’d send messages to online matches as described above over and over until you only feel mild anxiety doing so.
Next, you’d engage in a slightly more challenging exposure. Perhaps you’d graduate to asking matches to chat by video or phone.
With enough repeated exposure, you’d likely find that asking a match on a date only spikes your anxiety to 50, not 90. In other words, you’d likely still be able to go through with asking for a date, whereas before you may have avoided it or shut down entirely.
Designing exposures such that you stay within that “sweet spot” of anxiety (between 30 and 50) will challenge your central nervous system without overwhelming it. This in turn will allow your body-mind to get used to the feared stimulus rather than reinforcing your fears via avoidance or overwhelm.
Note that if you struggle with anxiety, you may hold yourself to unrealistically high expectations. For example, you may expect yourself to be able to strike up a conversation with a stranger without much stress. Such expectations, which ignore the reality of your anxiety, set you up for failure and shame.
For that reason, exposure therapy provides a wonderful reality check; it identifies concrete, small steps you can take toward your goals in a way that honors and accepts your nervous system’s current limits. Exposure therapy reflects the old adage “you have to crawl before you can run.”
“He who would learn to fly one day must first learn to stand and walk and run and climb and dance; one cannot fly into flying.”
Exposure therapy propels you toward your goal by breaking it down into bite-sized pieces. Rather than setting yourself up for failure by attempting to face your biggest fears head-on, exposure therapy sets you up for a series of small but meaningful successes.
How to create an exposure hierarchy
The exposure hierarchy provides a structured roadmap for exposure therapy. In it, anxiety-provoking baby steps toward your ultimate goal are listed in order of challenge.
Here’s an example of an exposure hierarchy created for a socially anxious individual who wants to be able to speak to attractive strangers with less fear.
Here’s how to create an exposure hierarchy, step by step:
Write your goal at the top of the page.
What would you like to do that you currently avoid out of fear?
Be as specific and concrete as possible when identifying your goal and subsequent exposure tasks. For example, “I want to feel more confident” is much less actionable than “I want to speak to an audience of 100 people.”
Create a chart with four columns. Label the columns as follows:
Situation
Fear (0-100)
Avoidance (0-100)
Average (0-100)
In the first column, list baby steps you could take toward your goal. These are possible exposures.
Next, estimate your fear and avoidance levels you’d experience for each exposure in the second and third columns.
To identify your fear levels, ask yourself, “how anxious would I feel in this situation?”
To identify your avoidance levels, ask yourself, “how likely am I to avoid this situation, either overtly or covertly?”
Overt avoidance = not engaging in the situation at all, e.g. not going to a party you’re invited to.
Covert avoidance = less obvious distancing tactics, e.g. going to the party but not engaging socially by avoiding eye contact, staring at your phone, or volunteering to help clean up in order to avoid conversations with strangers.
After logging your fear and avoidance levels, average the two in the final column.
Sort your hierarchy according to the averages in the final column.
Note the first exposure that falls within the 30-50 sweet spot. That, my friend, is your first exposure.
Engage in the exposure you’ve identified repeatedly. Research indicates that exposure therapy is most effective when utilized for 3-5 hours per week, but even a few minutes can be beneficial.
When your fear level consistently remains below 30 when engaging in an exposure, move on to the next rung in your hierarchy.
Update the numbers of your hierarchy as your anxiety levels adjust. This will help to ensure that you’re choosing exposures in your current anxiety sweet spot.
Exposure therapy pro tips
Take note of your avoidance levels
Incorporating avoidance levels in the hierarchy ensures you identify exposures that are truly in your anxiety sweet spot.
Most exposure hierarchies focus solely on tracking fear levels. I recommend averaging fear with avoidance levels when you create your hierarchy, as unacknowledged avoidance can skew your self-assessment such that you set yourself up for too much challenge too quickly.
Note that the “fear” section of the hierarchy aims to measure the intensity of physical and mental symptoms of anxiety, e.g. racing thoughts, pounding heart, sweat, rumination, stuttering, etc.
Avoidance is a behavioral symptom of anxiety wherein you steer clear of situations that will spike your anxiety.
It may be tempting to judge your tendency to avoid harshly, seeing it as a character flaw. In truth, avoidance is a symptom of anxiety, not a moral failing.
Some people avoid the things that make them anxious so successfully that they don’t realize how anxious those situations actually make them.
For example, someone who typically avoids speaking to strangers might estimate they’d feel mild fear when striking up a conversation with an unfamiliar grocery store clerk. Because they don’t have much experience speaking to strangers, they might be prone to underestimating their anxiety response.
Such an underestimation could prompt them to attempt an exposure that’s actually well above their anxiety sweet spot. When the time comes to initiate pleasant banter with their grocery store clerk, they might upexpectedly freeze up and mindblank. Disappointed and ashamed, they might in turn conclude that they’re incapable or that exposure therapy doesn’t work for them.
So, please make sure to note your avoidance level and average the “anxiety” and “avoidance” numbers to get a more accurate sense of your overall anxiety level
The 30-50 “sweet spot” is, by nature, subjective
Some find it easy to identify their fear temperature on a scale of 0-100. Others struggle to quantify their anxiety.
Here’s a helpful way to think about this range if you’re struggling with giving your anxiety a number:
Anxiety levels below 30 produce very mild and at times unnoticeable symptoms. We largely feel grounded and present with moments of mild fear that at times may feel like extra energy or even excitement.
At an anxiety level of 30, most people experience mildly uncomfortable anxiety symptoms. This level typically arises when we take a small but noticeable step outside our comfort zone.
Many people describe an anxiety level of 50 as moderately uncomfortable. It arises when we’re several steps out of our comfort zone.
Anxiety levels above 50, we tend to move into fight, flight, or freeze to the degree that we lose our usual capacities. For example, our mind we may freeze, mind blank, talk incessantly, or leave the situation entirely.
If you feel uncertain about your fear levels even with the above guidelines, just take your best guess. The fear temperature is inherently subjective, so it’s impossible to get “right.” Don’t let perfect be the enemy of the good.
“The perfect is the enemy of the good.”
fine-tune these exposure elements to achieve your anxiety sweet spot
If you’re struggling to identify exposures that increase your anxiety level to the right range, finding you either undershoot or overshoot your sweet spot, try adjusting either small, concrete details OR the exposure type altogether.
Concrete elements you might adjust to modify the anxiety level in your exposure include:
Exposure location (e.g. in a busy mall vs. at home)
Proximity to others (e.g. at a distance vs. sitting next to someone)
Eye contact (e.g. a glance vs. an extended gaze)
Non-verbal expressions (e.g. smiling vs. frowning)
Verbal expressions (e.g. saying hello vs. asking a question)
Appearance (e.g. neutral garb vs. ostentatious attire)
For example, if simply making eye contact with a stranger only increases your anxiety to a 20 and making eye contact while saying hello spikes it to a 70, an in-between exposure might be making eye contact while smiling.
In addition to adjusting the concrete details of an exposure, keep in mind that you can adjust the exposure vehicle altogether if needed. You don’t need to do something “in vivo,” i.e. in real life, in order to reach an anxiety level between 30 and 50.
When starting exposure therapy, many people simply need to visualize, talk about, or role-play an anxiety-provoking situation in order to get into their anxiety sweet spot.
So if approaching a stranger in public spikes your anxiety above 50, consider visualizing as much, discussing it with a therapist, or even role-playing it in your next therapy session.
Remember, the principle behind exposure therapy is systematic desensitization, i.e. targeting your sweet spot repeatedly in order to reduce your fear response to a particular stimulus. Whether you do that via visualization or “in vivo” doesn’t matter. The content of the exposure is much less important than finding creative ways to face your fears in reasonable and tolerable baby steps.
Remember that exposure therapy is an iterative process
Exposure therapy is a process of experimentation and data analysis. Identifying exposures that work for you may take time and creative problem-solving.
For that reason, treat your exposure hierarchy as a living document, one that you adjust and update as you gather data through your exposures.
It can be incredibly helpful to work with a skilled anxiety therapist, who can help you overcome the obstacles that naturally arise in exposure therapy.
Use accountability systems to ensure you actually complete your exposures
Avoidance is not only a symptom of anxiety, it’s also a learned, self-perpetuating behavior, not to mention one exposure therapy’s greatest saboteurs.
Find ways to hold yourself accountable to your exposure goals. Consider implementing:
the buddy system, a.k.a. an accountabillibuddy.
alarms/timers.
scheduling, i.e. blocking off time for your exposures.
bundling, i.e. pairing exposures with something you enjoy.
rewards.
professional accountability, e.g. working with an anxiety therapist.
Research shows that we’re more likely to achieve goals that we’ve written down. We’re also more likely to achieve our goals when they’re SMART, i.e. specific, measurable, attainable, relevant, and time-bound.
👉 Take our free SMART Goals mini-course.
Here’s a sample exposure therapy plan template you might fill out in order to increase your chances of exposure therapy success.
This week, I commit to doing ___ hours of exposure therapy.
At _______ (time) on ________(date), I will (exposure task) ______________________ at ____________________(exposure location).
For accountability, I have:
🔲 Put this event on my calendar
🔲 Set an alarm/reminder
🔲 Stated my goal publicly
🔲 Asked a buddy to join me
🔲 Committed to “bookend” with a buddy, i.e. text/call before and after
After completing my exposure therapy, I will reward myself with ________________.
Ready to get help using exposure therapy to build confidence and overcome social anxiety or dating anxiety? Reach out now to get started with an online social anxiety therapist.