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Approaching feared social situations






As we discussed in chapter 8, avoiding the things you fear, when these things are not actually dangerous or threatening, will only exacerbate your fear. If the social situations feared by people with social anxiety were truly dangerous or life threatening, we would teach you skills to avoid them, in much the same way we teach children not to get into cars with strangers. With social anxiety, however, people come to fear all kinds of social situations that are not inherently dangerous. And, because they then avoid these situations, their fear continues and may intensify. Therefore, just as we discussed in the case of panic attacks and PTSD symptoms, the way to conquer this fear and keep social anxiety from hurting your life is to approach the situations you have been avoiding.

To begin to apply this skill to social anxiety, use the following exercise to identify all of the social situations you have been avoiding in your life. Remember that these situations can vary in terms of the number of people who are actually present, ranging from one to two people to large crowds. You may find it helpful to refer back to exercise 10.1 to help you identify all of the situations you have been avoiding. Write down these situations in the first column.

Next, try to come up with some small, doable steps you can take to begin to approach these situations. What can you do to put yourself in these situations? Think about all of the things you can do to get yourself in contact with these situations and the small steps you can take to act opposite to your fear. For example, if you are afraid of eating in front of other people, perhaps you can start by chewing some gum in front of your best friend or snacking on some peanuts as you walk down the street. You don’t need to begin by having a five-­course dinner in front of a new date. All you need to do is start breaking down your avoidance of these activities one step at a time. Write down the steps you come up with in the second column.

Exercise 10.2 Beginning to Approach Feared Social Situations

Write down all of the social situations you have been avoiding out of fear of being avaluated. Write down up to five steps you can take to begin to approach this situation. Focus on small, doable actions.
  1. 2. 3. 4. 5.
  1. 2. 3. 4. 5.
  1. 2. 3. 4. 5.
  1. 2. 3. 4. 5.
  1. 2. 3. 4. 5.

Nice work! As we discuss throughout this book, just identifying the steps you can take to begin to break the cycle of avoidance in anxiety disorders is a huge first step in overcoming the hold anxiety can have on your life. Just thinking about approaching these situations can be extremely anxiety provoking, so taking the time to identify all of the things you can do to begin to get into contact with these situations is an important step on your road to recovery. The next step is to begin to make your way through this list, doing one thing at a time to approach these situations and conquer your fear.

Use skills for tolerating anxiety. Now, we realize that approaching the situations that scare you the most is probably easier said than done. Even if you understand the principles behind the skill of acting opposite to your fear and know on an intellectual level that avoiding these situations will only make your anxiety worse, it may still be incredibly difficult to bring yourself to approach them. And if you do begin to take steps to approach these situations, you will likely experience a lot of anxiety. Therefore, as you begin to approach your feared social situations, it can be useful to combine the skill of acting opposite to your fear with other DBT skills focused on helping you tolerate anxiety.

One of the most useful skills for tolerating anxiety is actually a simple one: breathing (Linehan 1993b). And, yet, just because this skill is simple does not mean it is easy to do. Surprisingly enough, most people in this world don’t actually know how to breathe correctly, and a lot of people breathe in a way that can actually increase their anxiety. So, one basic skill for managing anxiety is simply to learn how to breathe properly. And this means learning how to use your diaphragm (the big muscle between your lungs and your stomach) to breathe.

So, how do you know if you’re breathing properly? Take a few minutes to breathe in and out slowly. As you breathe, notice the parts of your body that move in and out or up and down with each breath. If you are breathing properly, your belly should push out when you breathe in and go back in when you breathe out. If your belly expands and contracts as you breathe, you are using your diaphragm to breathe. If, on the other hand, your shoulders move up and down as you breathe, you are probably not breathing properly, and you may be putting yourself at risk for more anxiety.

Training yourself to use your diaphragm to breathe will help you take deeper breaths, and taking deeper breaths means breathing slower. Deep, slow breathing is the body’s natural way of combating anxiety. In fact, breathing out slowly can actually slow down your heart rate when you are anxious. Therefore, deep breathing is one of the most basic strategies for tolerating anxiety. The following exercise, adapted from our book Freedom from Self-­Harm (Gratz and Chapman 2009), provides some simple step-­by-­step instructions for learning how to breathe deeply. Try it and see how it works!

Exercise 10.3 Learn How to Breathe Deeply

When you first practice this exercise, try to do it at a time when you already feel relaxed. It’s easier to learn the basic techniques of deep breathing when you’re not stressed out.

1. Find a comfortable and quiet place to practice your breathing. Sit up in a chair so that your back is straight and supported.

2. Close your eyes.

3. Put the palm of one of your hands on your stomach and the other on your chest across your breastbone.

4. Breathe in and out as you normally do. Which hand moves the most when you breathe? The one on your belly or the one on your chest? If the hand on your chest moves and the one on your belly doesn’t, this means that you’re not breathing with your diaphragm.

5. Now, when you breathe in and out, deliberately push out your belly when you breathe in, and let your belly fall when you breathe out. It may feel slightly unnatural at first. This is normal, and this feeling will go away very quickly with practice.

6. Continue to breathe in and out. Try to lengthen your breaths. Slowly count to five as you breathe in, and again when you breathe out. Also, try to breathe in through your nose and exhale through your mouth. This may help you take deeper breaths.

7. Practice this breathing exercise a couple of times a day. The more you practice, the more it will become a habit.

Once you’ve practiced this exercise a few times and are more familiar with deep breathing, try it when you feel anxious. Even though it may seem simple, changing your breathing can have a profound effect on your anxiety.

Another skill that can help you tolerate the anxiety you will probably feel when you start approaching social situations is progressive muscle relaxation (PMR), introduced earlier in this book, which involves tensing and then relaxing all of the various muscles in your body. This skill is one of the best around for reducing anxiety and promoting relaxation. Follow these steps, adapted from our book Freedom from Self-­Harm (Gratz and Chapman 2009), to begin to practice PMR.

Exercise 10.4 Simple Steps for Practicing Progressive Muscle Relaxation

Follow these steps to practice PMR.

1. Find a quiet place where you won’t be disturbed, and get into a comfortable position. You can do this lying down, sitting up, or even standing up, but you might find that it works best if you’re lying down.

2. Find a place on your body to start the exercise. Many people find it helpful to start with the top of the head or the tips of their toes.

3. Bring your full attention to that part of your body. Let’s say that you’ve started with your forearms. Imagine that your whole focus is being drawn down to your forearms. Then, clench your hands into fists, squeeze to about 75 to 80 percent of your maximum strength, and hold this tension for about five to ten seconds.

4. Let go and relax your muscles. Notice the difference between how they felt when they were tense and how they feel now. Just notice any sensations of relaxation or warmth, or anything else you might experience.

5. Repeat that process, first tensing the same muscles, holding that tension for five to ten seconds, and then relaxing those muscles.

6. Move to another area of your body. For instance, you might try your lower legs. Focus your attention on your calf muscles, and really try to clench them. Hold for five to ten seconds again, and then let go, relaxing your calves. Repeat this process to really relax those muscles.

7. Continue going through different muscle groups in your body, doing exactly the same thing. Each time, just tense your muscles about 75 to 80 percent for about five to ten seconds, and then relax them, focusing on the difference you feel.

Do PMR for five to twenty-­five minutes, depending on how much time you have. Even doing it for five minutes can make a difference. So, try it out and see how much better you feel!


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