"Examples of in Vivo exposure tasks to challenge estimated social cost"

[Cookie-Monster]

So I'm reading "Cognitive Behavioural Therapy For Social Anxiety Disorder" by Hoffman and Otto and one of their recommendations for tackling this disorder was to engage in tasks that "challenge estimated social cost" (pretty much the same thing as "shame attacking exercises"). Here are the examples they give:

* ask multiple people (e.g., 10 people over a half hour) in a specifc and obvious location (e.g., immediately outside Fenway Park) where to find that location. say: Excuse me, I am looking for Fenway Park.

* order a sandwich at a takeout restaurant and then tell the cashier you cannot buy it because you do not have enough money. say without apologizing: I just realized that I forgot my wallet, then walk out.

* order a coffee at a coffee bar and when it is handed to you, say: Is this decaf? add without apologizing: I would like to have mine decaf.

* order a bagel, ***8220;accidentally***8221; drop it on the foor and ask for a new one. say: I just dropped the bagel on the foor. Could I please have a new one?

* Go to a restaurant and sit at the bar. When asked if you would like to order something, just ask for tap water. use the bathroom and then leave without saying anything.

* Go to a restaurant and sit at the bar. ask a fellow patron whether he has seen the movie When Harry Met Sally and who the actors were.

* Go to a hotel and book a room. Walk outside and immediately back in and cancel the room because you changed your mind.

* Go to a video rental outlet and rent a dVd. Walk out and immediately back in requesting to return it saying: I forgot I don***8217;t have a DVD player.

* stand in a subway station (specify location) and sing ***8220;God bless
america***8221; for 30 minutes.

* ask a female pharmacist for some condoms. When she brings them, ask: Is this the smallest size you have?

* Go to every man sitting at a table in a crowded restaurant and ask: Are you Carl Smith?

* Go to a bookstore and ask a clerk: Excuse me, where can I fnd some books on farting.

* ask a bookstore clerk for the following two books: The Karma Sutra and The Joy of Sex. ask the clerk which one he would recommend.

* buy a book and immediately return it because you changed your mind.

* ask the book clerk for his/her opinion about a particular best-seller. ask: What did you like about this book, and how many copies have you sold. don***8217;t buy it. simply say: Thank you. I will think about it and leave.

* ask a book clerk for a book for a 1-year-old. Find out if and how many children the clerk has, how old they are, what school they attend or attended, and what their favorite color is.

* Go to store 24, buy a Playgirl magazine, and ask the store clerk: Are there also pictures of naked men in the magazine? Wait for the answer and put it back on the shelf.

* Wear your shirt backward and inside out and buttoned incorrectly in a crowded store. Goal: look three people in the eye.

*Walk backward slowly in a crowded street for 3 minutes.

Are these guys for real? Do they even have a ****ing clue what its like to have this dreaded illness? I came away feeling angry, frustrated, depressed and feeling even worse about myself because I know I couldn't possibly do the majority of those exercises while being sober. I've seen similar examples in other cbt books and its one of the reasons why I'm so pessimistic about this kind of therapy. I don't think these therapists really have a proper understanding of this illness.

[Wol]

Originally Posted by Cookie-Monster

I couldn't possibly do the majority of those exercises while being sober.

Which one's could you do?

My problem with these exercises is that it's not the social consequences that are the problem, it's the internal consequences that I worry about.
If I were to do the singing in a station (the worse one for me) then I know that people's reactions wouldn't matter practically, but the mental torture of embarrassment I would put myself through every time I thought about it would be extreme.
Maybe by doing enough of them I would learn not to hurt myself this way, but that's something I don't yet trust.

[Fritzz]

wow, a lot of those exercises sound like they tackle the problem the wrong way round. There's no 'small' exercises there, just tackling the problem head on with 'huge' exercises. Or maybe that's just my opinion.
I think your should make up and set about doing your own 'smaller' tasks, get the sense of achievement, and then move on to some of the ones that they have suggested.
Just my 2 cents.

[threadbare]

Originally Posted by Cookie-Monster

So I'm reading "Cognitive Behaviour Therapy For Social Anxiety Disorder" by Hoffman and Otto and one of their recommendations for tackling this disorder was to engage in tasks that "challenge estimated social cost" (pretty much the same thing as "shame attacking exercises"). Here are the examples they give:



Are these guys for real? Do they even have a ****ing clue what its like to have this dreaded illness? I came away feeling angry, frustrated, depressed and feeling even worse about myself because I know I couldn't possibly do the majority of those exercises while being sober. I've seen similar examples in other cbt books and its one of the reasons why I'm so pessimistic about this kind of therapy. I don't think these therapists really have a proper understanding of this illness.

i thought you were recommending these excercises for a minute there. they sound horrific.

i can't imagine doing these things would make me feel any less mental - just mental in a different way.

i'd consider that a very aggressively over-compensatory approach. there are hundreds of other techniques out there which might suit you better. i don't think there's anything wrong with listening to your own instincts on this and going with something less extreme - what might work for some, doesn't always necessarily work for others anyway.

[Jaaames]

Jesus... that sounds like the kind of thing someone with no understanding of social anxiety would recommend.

[benney]

Originally Posted by Cookie-Monster

So I'm reading "Cognitive Behaviour Therapy For Social Anxiety Disorder" by Hoffman and Otto and one of their recommendations for tackling this disorder was to engage in tasks that "challenge estimated social cost" (pretty much the same thing as "shame attacking exercises"). Here are the examples they give:



Are these guys for real? Do they even have a ****ing clue what its like to have this dreaded illness? I came away feeling angry, frustrated, depressed and feeling even worse about myself because I know I couldn't possibly do the majority of those exercises while being sober. I've seen similar examples in other cbt books and its one of the reasons why I'm so pessimistic about this kind of therapy. I don't think these therapists really have a proper understanding of this illness.

ive got to be honest when i read that list i was thinking ''these taks are way too easy''.

the only one that i would either bottle out of or take a long long time convinving myself to do it is the singing in subaway for 30 mins . all the others id do straight away

of course these people know what this illness is like. if you have a major problem with embarrasment , if you blush all of the time and if you overestimate the consequences of being embarassed infront of people then what better way than to go out there and do embarrassing things and learn that it really isnt that bad ?

[benney]

Originally Posted by matt24seven

wow, a lot of those exercises sound like they tackle the problem the wrong way round. There's no 'small' exercises there, just tackling the problem head on with 'huge' exercises. Or maybe that's just my opinion.
I think your should make up and set about doing your own 'smaller' tasks, get the sense of achievement, and then move on to some of the ones that they have suggested.
Just my 2 cents.

id call all of those exercises , bar 1 , small.

in exposing yourself to embarrasment you really cant start any smaller than ordering a sandwich , dropping ont he floor and then asking for a new one. how smaller can you go.

in exposing yourself to emmbaraasement you have to end big. now i would call big walking naked through the street . but how to build up to that ? by starting small. so what is a small embarrassing thing to do ? well pick any number off that list apart from singing in subway

[teal]

A lot of those just seem like a test of how rude and selfish you can be. I don't think they would boost my confidence and I'd feel guilty about giving some poor person working in a sandwich shop or wherever on minimum wage and doing their best, a bad day unnecessarily.

I did hear about some study where they put tons of blusher, a really abnormally large clown-like amount apparently, on people with SA and made them go out in the street. I think it worked because people in the street didn't react to them anywhere near as much as the SA people predicted they would.

[brian_maiden]

What a load of *****cks :rolleyes: If I bought a book with that rubbish in it, I certainly would take it back.

[threadbare]

my particular fave:

* Wear your shirt backward and inside out and buttoned incorrectly in a crowded store. Goal: look three people in the eye.

[gingercat]

I don't think those things would make much difference to me. They might help some people I guess, for example if being embarassed in front of strangers is their main fear. I could do any of those things far more easily than I could ask someone out on a date or be relaxed around a group I'm trying to make friends with. Exposure has to be done for a reason and it has to be directly related to whatever makes you most anxious in my experience. You can't just do something outrageous or obnoxious that you'd never normally do (or even want to do) and expect it to improve your confidence.

[brian_maiden]

It could actually make things worse...

Worrying you look like an idiot normally + doing things that actually DO make you look like an idiot = validation of your fears.

You could end up feeling worse than before and worrying that by doing even normal things, people will react to you in the same way as when you did those stupid things. Which is probably how you felt before, only worse.

[Cookie-Monster]

Originally Posted by Wol

Which one's could you do?

I could do this I guess:

Go to a restaurant and sit at the bar. When asked if you would like to order something, just ask for tap water. use the bathroom and then leave without saying anything.

I've gone into a bar/pub just to use the toilet before so asking for some water beforehand wouldn't be so bad. And maybe I could do the booking the hotel room and then cancelling it (and also returning the book immediately after buying it). The rest are out of the question. I'd have to be heavily under the influence of chemicals to attempt any of them.

My problem with these exercises is that it's not the social consequences that are the problem, it's the internal consequences that I worry about.
If I were to do the singing in a station (the worse one for me) then I know that people's reactions wouldn't matter practically, but the mental torture of embarrassment I would put myself through every time I thought about it would be extreme.

Yep, that's pretty much the same issue with me.

[benney]

if you blush and you are absolutely terrified of blushing and you think lots or mortifying things will happen if you blush. and you therefore restrict your life by avoiding situations incase you blush then your life will be miserable.

if you can do something embarrassing and realise that all of those mortifying things, that you predicted would happen, dont happen and if you relaize that things werent even that bad and you can easily handle then that can only be a good thing

if you realize that bad things dont happen when you blush and if you realize that you can easily handle embarrasment then you can stop restricting your life by avoiding situations incase you blush. this can only be a good thing right ?

lets say i want a girlfriend but i avoid girls cos i blush infornt of them . if i go and sing in subway for 30 mins and realize that either nothing bad happens when i do it or something bad happens but it didnt end up being a catasthrophy like i thought it would be and i easily handled. then i can approach girls and not care if i get embarrased infront of them .

now i have the chance of not dying alone .

whats the problem ? you all need to lighten up . its a gud thing

[cheesehoven]

One useful exposure exercise they missed

* Go back to the bookstore where you bought this book and demand your money back. If they refuse quote some of the unsuitable exercises here.

While there are a couple of straightforward things there, most of the things would be rude and lacking consideration for others. I'm not sure if they tackle feelings of guilt and remorse elsewhere in the book.
Most of the exercises give me a feeling of anxiety just looking at them.

[benney]

Originally Posted by brian_maiden

It could actually make things worse...

Worrying you look like an idiot normally + doing things that actually DO make you look like an idiot = validation of your fears.

You could end up feeling worse than before and worrying that by doing even normal things, people will react to you in the same way as when you did those stupid things. Which is probably how you felt before, only worse.

usually if your fears do come true e.g you look like an idiot , you realize that its not even that bad anyway and you can easily and handle and best of all its not something that needs to be avoided anymore.

the goal is to not do something to prove that your fears dont come true but its to do something to prove that your fears probably wont come true but even if they do its nothing anyway , its harmless

[Cookie-Monster]

Originally Posted by benney

usually if your fears do come true e.g you look like an idiot , you realize that its not even that bad anyway and you can easily and handle and best of all its not something that needs to be avoided anymore.

the goal is to not do something to prove that your fears dont come true but its to do something to prove that your fears probably wont come true but even if they do its nothing anyway , its harmless

I actually tried one of Albert Ellis's shame attacking exercises a couple of months ago in desperation - asking random people for a dollar (pound in my case). I tried it with 5 people and then could not bring myself to do any more. I ended up getting severely frustrated and angry with myself and took it as more proof of being a spineless coward (I am an expert at mental self-flagellation). So I'm sorry, I don't think these cbt quacks really understand the mindset of someone suffering from this problem.

[benney]

Originally Posted by Cookie-Monster

I actually tried one of Albert Ellis's shame attacking exercises a couple of months ago in desperation - asking random people for a dollar (pound in my case). I tried it with 5 people and then could not bring myself to do any more. I ended up getting severely frustrated and angry with myself and took it as more proof of being a spineless coward (I am an expert at mental self-flagellation). So I'm sorry, I don't think these cbt quacks really understand the mindset of someone suffering from this problem.

thats just you personally though , you sound like an exceptionally uptitght person who is extremely hard to please and puts a negative spin on absolutely everything

not everyone is gonna react the same way as an extreme negatist like urself

[cheesehoven]

Originally Posted by Cookie-Monster

I actually tried one of Albert Ellis's shame attacking exercises a couple of months ago in desperation - asking random people for a dollar (pound in my case). I tried it with 5 people and then could not bring myself to do any more. I ended up getting severely frustrated and angry with myself and took it as more proof of being a spineless coward (I am an expert at mental self-flagellation). So I'm sorry, I don't think these cbt quacks really understand the mindset of someone suffering from this problem.

That is one of the hardest exercise anyone could do IMO. Even highly confident salesmen become demoralised and demotivated after constant rejection. As you say, it merely reinforces your existing programming if done incorrectly.
I would suggest exercises in which you have a good chance of success to begin with.

[gingercat]

It wouldn't necessarily make things worse to do those things. I don't think it would make me worse. I just don't think it would make me better either.

I get anxious about revealing my true self and my real feelings. Singing in the subway wouldn't challenge those anxieties at all because it wouldn't be the "real" me... I'd be putting on a whacky and very false act. It actually wouldn't make much difference how people responded to me because whatever they did I'd know they weren't judging the real me, just the act.

I do speak from a bit of experience on this... I've been involved in shows and film making and done things in public that most people would consider quite weird. For example singing and dancing on a tree stump in a busy park for hours while my friends filmed me. It really didn't bother me very much what passers by were thinking. But trying to drop all the acts and let other people see when I'm sad, or angry, or attracted to someone... now that scares me!

(I realise I'm probably in the minority on this here... wouldn't want to put anyone else off trying something that might help, so if you feel it could help you, go for it).

[brian_maiden]

Originally Posted by benney

usually if your fears do come true e.g you look like an idiot , you realize that its not even that bad anyway and you can easily and handle and best of all its not something that needs to be avoided anymore.

the goal is to not do something to prove that your fears dont come true but its to do something to prove that your fears probably wont come true but even if they do its nothing anyway , its harmless

That's easy to say, but how many SA people will that work for? very few I would expect.

Given that a fairly common SA trait is to go home and do 'post mortem' of events and find faults and things to be embarrassed and feel bad about, even if they didn't see them at the time, do you really think that people are going to go home having definitely done something embarressing and just dismiss it as not as bad as they thought?...

I'd think it far more likely they will go home and cringe about it months or years to come! :rolleyes:

[Cookie-Monster]

Originally Posted by cheesehoven

That is one of the hardest exercise anyone could do IMO. Even highly confident salesmen become demoralised and demotivated after constant rejection. As you say, it merely reinforces your existing programming if done incorrectly.
I would suggest exercises in which you have a good chance of success to begin with.

His (Ellis's) first suggestion was actually to ask strangers for $100! If that was out of the question he proposed going lower to a dollar.

[Optimistic]

Originally Posted by benney

thats just you personally though , you sound like an exceptionally uptitght person who is extremely hard to please and puts a negative spin on absolutely everything

not everyone is gonna react the same way as an extreme negatist like urself

That's not very nice to post on a SA forum. I know many people who don't have SA who couldn't do those tasks on the list. If you can do all but one, without anxiety, then in what way do you have SA now and what other tasks would you consider to be hard to do (since you said all but the singing one was easy)?

If you think he is an 'extreme negatist' then so are a lot of people with SA then. People with SA overly beat themselves up too much so you decide to criticise one for saying that he had the guts to try to face his fears.

Its not "exceptional" or "extreme" for SA sufferers to think that as I suffer from social anxiety, and I force myself into extremely highly anxiety producing situations, then I may judge myself negatively (due to a sympton of SA) and create more anxiety in future.

In fact, this is the reason the main choice of therapy for SA is CBT and not just BT. I guess most SA sufferers must be "exceptionally uptight" and an "extreme negatist".

you all need to lighten up .

If we "all" need to lighten up, perhaps its more likely that you're missing an understanding of how SA effects others. If we could just get over extremely highly anxiety producing situations that even nonSA sufferers wouldn't like to do by just "lighten up", it wouldn't be a severe mental disorder would it and the cure would be prettty damn easy.

[Sneddonia]

Originally Posted by gingercat

Exposure has to be done for a reason and it has to be directly related to whatever makes you most anxious in my experience. You can't just do something outrageous or obnoxious that you'd never normally do (or even want to do) and expect it to improve your confidence.

Exactly what I was thinking. You can't just give a list of outrageous things out and expect them to work for everyone. Personally, I wouldn't want to do any of those things, even if I was confident, because many of them are just rude, or would cause embarrassment or discomfort for other people. I may worry too much about people think, but I don't ever want to be the sort of person who doesn't consider others at all.

Originally Posted by brian_maiden

It could actually make things worse...

Worrying you look like an idiot normally + doing things that actually DO make you look like an idiot = validation of your fears.

You could end up feeling worse than before and worrying that by doing even normal things, people will react to you in the same way as when you did those stupid things. Which is probably how you felt before, only worse.

Absolutely. I would probably end up not leaving the house at all after doing some of those things! I'd think people were looking at me thinking "She's that nutter that was singing to herself". Also, having had several customer-facing jobs, being an awkward customer is just something that I would not do.

[Cookie-Monster]

Thanks for sticking up for me there Optimistic. I don't think Benney suffers acutely from this disorder so doesn't understand what's its like for people in our position. Or he's just being an ass.

[Sneddonia]

Quite possibly a bit of both.

[Holz]

I understand what they're trying to say with these exercises, but like people have said there's no way whatsoever I could ever do 99% of those.
What I think would have been better to do is to start off with really little things like wear clashing clothes, run for a bus you know you'll miss etc. Still puts you in those situations but not so much that you feel you can never show your face there again, then build it up from there until you can manage those things in the book. There is a name for that kind of treatment but I can't remember what it's called without digging my psychology books out from last year, but yeah

[benney]

Originally Posted by Cookie-Monster

Thanks for sticking up for me there Optimistic. I don't think Benney suffers acutely from this disorder so doesn't understand what's its like for people in our position. Or he's just being an ass.

well actually i have avoidant personality disorder and have had it since i was only 5 years old. my SA is as extreme as it gets, id be extremely suprised if there was anyone out there who was worse than me

ive tried many similar exercises and found them way too easy, so then i did harder things , a lot harder and although it was difficult it deffinately worked in the end

im speaking from experience , the veiwpoint after having gone through it. most people on here are speaking from a veiwpoint that is based ont heir own expectations, no actual real life proof. they think it will be a bad idea , they THINK that. i know its a good idea and its not just cos i THINK its a gud idea its cos ive been there , done it , seen the real life evidence , so i know its a good idea

if you blush and you ever want to get over it you are gonna have to do things were the risk of embaraasment is present. lets say you avoid going to the crowded canteen in work for your dinner incase you blush infront of everyone. instead you spend your dinner time at your desk alone

now if you want to get over that fear of blushing you are gonna have to go to the canteen and risk blushing infront of everyone , risk looking foolish and risk getting embarrassed .

whats the difference in that and going to a sandwich bar and deliberately dropping a sandwich ont he floor ? they are both the same , they both risk embarrassment .

you dont have to go and sing in subway for 30mins , i think that would be too extreme for a lot of people and cud prove to be a bad experience but most of the things on that list arent extreme at all.

ask a stranger for directions
ask someone for money
drop a sandwich

they all contain the same risk of embarrasment as taking a conventional root like going to the canteen or going to the barbers for a hair cut

[hardy]

Maybe its quoted out of context. Perhaps theyre just suggestions of the type of thing you MIGHT try of varying possible levels .
Perhaps in the actual text it recommends not nessesarily using their examples but devising tasks of your own that gently push your boundaries . Which is more like what is usually recommended in CBT.


ps people vary in Sa level quite a lot - I could do about half of those tasks

[Sneddonia]

Originally Posted by Holz

There is a name for that kind of treatment but I can't remember what it's called without digging my psychology books out from last year, but yeah

Graded exposure?