question reguarding habituation and exposure thearpy

[david90]

I have an avoidance disorder and I get anxious around people. I've been reading this article

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=9738&cn=353

and it is saying that exposure therapy works because of habituation.

I have been around people for many years (daily interaction) yet my level of anxiety is still somewhat the same. Why is that? For some reasons I think finding the answer to this question will help me understand my problem better. I think the reasons why I'm anxious around people is that I'm afriad of rejection but I should have "habituated" through many years of interacting with people.

Thanks

Edited August 8, 2008 by david90

[Guest ASchwartz]

Hi david90 and welcome to our community,

It is difficult to give you a definitive answer as to why your exposure to people has not reduced you anxiety. There are great variations among people as to the amount and intensity of the anxiety they experience and there is a question as to what you diagnosis might be. Perhaps you do have an avoidant personality and perhaps not.

In addition, it appears that you have tried to help yourself with this problem and that is excellent. While self help works well for many people for others it becomes necessary to seek professional help. It appears that you may be one of those people. I think that seeing a psychologist who is trained and skilled in Cognitive Behavioral therapy as well as exposure therapy could make the difference for you.

Having said all of this I wonder if you could tell us more about yourself so that we can better understand your difficulties.

Allan:)

[Natalie]

A great question, David90.

Straightforward exposure therapy is usually better for Simple Phobias, such as an intense fear of snake, bridge etc. Here the idea is that often, people with these types of phobias have unrealistic thoughts about the dangerousness of specific items/situations, and that exposure therapy helps them to shake those unrealistic thoughts and realize that "I can be around a snake, etc. and not die, etc.."

Many times, people with Social Anxiety have more difficulties with other types of thought patterns that make them anxious. So, most people with social anxiety don't have the problematic thought that "people are dangerous" or "people are going to kill me" per se. It's more along the lines of "other people are judging me" "other people think I'm a failure, I am stupid", etc., etc. Exposure therapy, or just simply being around other people, isn't going to attack that type of thought.

So, to simplify, a Cognitive Behavioral approach is best for treating Social Anxiety. With this type of therapy, the clinician will help you identify and challenge and change your unhelpful thoughts (cognitive piece). Then, the clinician will help you practice in any areas that you may need assistance in (social skills, assertiveness, whatever, which is the behavioral piece). Finally, the exposure piece will be used, to enable you to practice the new thoughts and the new behaviors in the social setting.

Hope that helps clarify a bit.

[david90]

Hi david90 and welcome to our community,

It is difficult to give you a definitive answer as to why your exposure to people has not reduced you anxiety. There are great variations among people as to the amount and intensity of the anxiety they experience and there is a question as to what you diagnosis might be. Perhaps you do have an avoidant personality and perhaps not.

In addition, it appears that you have tried to help yourself with this problem and that is excellent. While self help works well for many people for others it becomes necessary to seek professional help. It appears that you may be one of those people. I think that seeing a psychologist who is trained and skilled in Cognitive Behavioral therapy as well as exposure therapy could make the difference for you.

Having said all of this I wonder if you could tell us more about yourself so that we can better understand your difficulties.

Allan:)

Well I'm 25,male and I have a mild social anxiety. My social anxiety is not too extreme where I can't go out of my house for weeks but it is at a level where it is hard for me to talk to people. I didn't have many friends in HS or college and never had a GF. I think I asked out only 5 girls in my entire life so I guess that is why. I am afraid of rejection and I'm not too good with criticism.

Thank you for the responses. This site is great!

Edited August 8, 2008 by david90

[david90]

A great question, David90.

Straightforward exposure therapy is usually better for Simple Phobias, such as an intense fear of snake, bridge etc. Here the idea is that often, people with these types of phobias have unrealistic thoughts about the dangerousness of specific items/situations, and that exposure therapy helps them to shake those unrealistic thoughts and realize that "I can be around a snake, etc. and not die, etc.."

Many times, people with Social Anxiety have more difficulties with other types of thought patterns that make them anxious. So, most people with social anxiety don't have the problematic thought that "people are dangerous" or "people are going to kill me" per se. It's more along the lines of "other people are judging me" "other people think I'm a failure, I am stupid", etc., etc. Exposure therapy, or just simply being around other people, isn't going to attack that type of thought.

So, to simplify, a Cognitive Behavioral approach is best for treating Social Anxiety. With this type of therapy, the clinician will help you identify and challenge and change your unhelpful thoughts (cognitive piece). Then, the clinician will help you practice in any areas that you may need assistance in (social skills, assertiveness, whatever, which is the behavioral piece). Finally, the exposure piece will be used, to enable you to practice the new thoughts and the new behaviors in the social setting.

Hope that helps clarify a bit.

Yes that makes sense. I think daily people interaction does not help me because I don't fear people per se. I just fear the possible rejection/judgement that could come from them. Since I avoid situation where I could be rejected/judged most of my life, I never habituate to rejection/judgment from people.

How do I overcome the catch 22 situation where I need to do what I fear to get rid of the fear? What if I can't do what I fear in the first to habituate myself to the fear?

I read the online self help book

http://www.mentalhelp.net/poc/center_index.php?id=353&cn=353

and it tells me to consciously reason with myself to lower the fear to the point where I can use exposure therapy but it doesn't work. I'm having trouble getting past the point where I'm strong enough to use exposure therapy.

Edited August 8, 2008 by david90

[david90]

I'm currently doing exposure therapy where I gradually face situations that I fear. For example I fear initiating contact with females that I don't know fearing that other people around me will laugh at me if I get rejected. Using CBT, I came up with competing alternatives to how people/female might see me when I get rejected

1. People will see that you got rejected and laugh at you.

2. People will have no reaction because they don’t care.

3. People will admire you for having the guts to approach a stranger.

4. She is not available.

5. She is having a bad day

6. She is not looking.

7. She is not attracted to you.

Knowing these alternative helps me but I'm still concern that alternative #1 might happen and that causes anxiety for me. Realistically I'm convinced that alternative #1 is unlikely to happen but it is possible. The small chance that #1 might happen makes me unease.

What should I do in this case? Is it fearing #1 a realistic belief? To me it is.

[Mark]

1. People will see that you got rejected and laugh at you.

in my experience, this is possible but unlikely. Most people are wrapped up in themselves too much to care much about what someone else is doing. bullies may do this sort of thing, however. In that case, you have to ask yourself further follow-on questions about getting at why that outcome is so difficult to face. Is it the fact for you that you care about what anyone on the planet things of you or just what some people think of you? If you make a distinction between some or all, what is the basis for that distinction. is it realistic to think that of the people whose opinion you actually care about, that they will attack you? etc.

Let's say that you are attacked by someone whose opinion you care about. Does the fact that they have revealed themselves to be someone who is willing to attack another person for a bad reason change how you evaluate the importance of their attack? It should, IMHO.

Another aspect here is to examine the perspective from which you are judging things. frequently, people in your situation (with social anxiety concerns) are judging yourself as though through the eyes of a critical outsider. the reason that it is so painful to think about critical judgement of youself is beucase that is what you are doing to yourself. How you are talking to yourself as you observe yourself. So - there's two sides to that coin. You can also learn to talk to yourself from a perspective where you are not a social object but rather simply speaking from inside your own body (not observing yourself). That sort of voice asks questions like, "what do I want", not questions like "how do I look when I do that thing" which is what someone outside yourself might ask. So - what is it that you want. If you can focus on that sort of way of thinking, some of your anxiety may lessen.

Finally, you can look into what the worst possible outcome might be. Let's say that for #1 the worst happens and someone whose opinion you care about laughs at you. then what? What is the worst thing that happens? Do you die? Probably not. More likely you feel uncomfortable for a while, call yourself names and then in a few hours/days life goes on. One way to handle this sort of fear is to do something deliberably that you are pretty sure will create a mild embarrassment reaction for you where someone disapproves of what you have done. Not sure what that might be - maybe it is burping in public or something . You can think about it and talk about it with your therapist and come up with something appropriate. Then you can expose yourself to that situation and see that while you may become uncomfortable, you also live throught the experience just fine. It can be scarey to do this sort of thing - like diving off a high diving board - but generally it isnt' that bad once you do it.

Mark

[david90]

Is it the fact for you that you care about what anyone on the planet things of you or just what some people think of you? If you make a distinction between some or all, what is the basis for that distinction.

Let's say that you are attacked by someone whose opinion you care about. Does the fact that they have revealed themselves to be someone who is willing to attack another person for a bad reason change how you evaluate the importance of their attack? It should, IMHO.

Yes I care what most people think of me (strangers, friends, family members). I don't care for opinions from people that I dislike/hate because I feel that their opinions of me has little or no credibility (little truth to it).

[Mark]

So - if you do make these sorts of distinctions between people whose opinions you take seriously and people you don't take seriously, that distinction is part of the way you start working on the social fears. If someone criticizes you (a worst case scenario) but you realize that you really don't at base take them seriously, then the reason for a fear reaction is lessened. You may still feel anxious, but less so.