Do Exposure Techniques Work for Dan?

Lately, I've gotten lots of emails from podcast fans who struggle with shyness, which is categorized in DSM5 (The Diagnostic and Statistical Manual of Mental Disorders) as "Social Anxiety Disorder." This is one of my favorite things to treat, since I struggled with practically EVERY type of social anxiety early in my life, so I really know how it feels and how to defeat it. It's incredibly common. In fact, when I give workshops for mental health professionals, I sometimes ask how many of them have struggled with shyness or public speaking anxiety, and nearly all the hands go up.

This podcast will be the first of several on this topic, because it's so common and relatively easy to overcome--IF you have the courage!

Here the are several different "flavors" of social anxiety recognized by the American Psychiatric Association, including:

1. Shyness
2. Public Speaking Anxiety
3. Performance Anxiety (such as intense anxiety during a musical or athletic performance)
4. Shy Bladder (or Bowel) Syndrome. This is the fear of peeing or pooing in a public restroom, for fear you'll freeze up or make too much noise and others will notice.
5. Test Anxiety

One common theme is the fear that others will notice your anxiety or poor performance and judge you. Another common source of suffering is shame of feeling like you are inherently flawed and will be seen as defective or even as insane by others. Sometimes, these fears become so extreme that they can significantly interfere with relationships and leisure-time activities as well as work.

Dan is a podcast fan who courageously immigrated to the United States from Iran as a young man. When he arrived in America, he had little education and almost no knowledge of English. He also suffered from an extreme case of acne, which eventually cleared up, but left him with severe social anxiety.

In spite of these problems, Dan worked hard, learned English, and became a top student in college and in graduate school as well, and went on to develop an excellent career. But in certain performance situations, such as public speaking or interacting with strangers, he panics and trembles and his heart races; his mouth twitches and his voice gets shaky, and he has thoughts like these:

1. I'm about to lose control over myself.
2. Others will see my symptoms and think I'm mentally insane.
3. In spite of making Herculean efforts to control these symptoms, I have failed.
4. I will never overcome this.
5. I am defective for life.
6. I will lose my job.

David and Fabrice remind listeners that they cannot treat anyone through a podcast, and that there are large numbers of treatment techniques that can be extremely helpful in the context of a compassionate and skillful therapeutic relationship. Since Dan is seeing an excellent therapist, they suggest and illustrate five powerful Interpersonal Exposure Techniques that Dan might want to do under the supervision of his therapist, including:

1. The Survey Technique
2. Self-Disclosure
3. The Experimental Technique
4. Shame Attacking Exercises
5. The Feared Fantasy Technique

David and Fabrice also discuss how to address patient and therapist fears of using powerful exposure techniques, and how the avoidance of exposure can sabotage the treatment. They describe four techniques David as developed to help therapists with this, including:

• Dangling the Carrot
• The Gentle Ultimatum
• Sitting with Open Hands
• Fallback Position

David describes "Reverse Hypnosis." This is where the patient hypnotizes the therapist into giving up on exposure thinking that it is "too dangerous," or that the patient isn't "ready" or is "too fragile."

And speaking of anxiety, listeners might want to consider the upcoming workshop by David and his colleague, Dr. Jill Levitt, on the treatment of anxiety disorders on May 19, 2019. Check it out below!

Also, I promised to post my list of 100 Shame Attacking Exercises, so here it is! It's not perfect, so please have low expectations. It does have some value.