Debbie feels anxious about the presentation she has to make to the board tomorrow. She is trying to get a good night’s rest, but finds herself tossing and turning, her heart is racing, and thoughts of failure run through her head. The last time she had to give a presentation to the board, she felt sick to her stomach and almost passed out. All she could think about was getting out of the room as soon as possible. Debbie suffers from a type of anxiety called social phobia or social anxiety. It is one of the most common forms of anxiety disorders.

Debbie began to experience social anxiety as a teenager. She struggled to give class presentations and always sat in the back of the classroom hoping not to be called on by the teacher. Her story is typical in that social anxiety begins early in life for most people–around the age of 11 and usually manifests by age 20. A concern with social anxiety is that it is a risk factor for depression and substance use. So it is best to treat it early.

So what can Debbie do? Successful treatment approaches generally involve medication combined with psychotherapy. However, cognitive-behavioral therapies have proven superior in placebo-controlled trials. And one type of cognitive behavioral therapy is worth a try. It is called exposure therapy.

Basically, Debbie would talk with the therapist about her irrational fears and learn to identify them. Then she would practice substituting rational thoughts (this is called cognitive restructuring). Debbie would also learn to do relaxation exercises to practice in the moment of feeling anxious. Finally, she would be gradually exposed to social situations that would prompt her anxiety, working through the anxiety until the situation was over. The more Debbie exposes herself to anxious situations, the easier they become and she builds the confidence that she can manage social situations. Eventually, her anxiety decreases and becomes manageable.

In some cases, people like Debbie might start by simply imagining situations like giving the presentation, notice how she feels and work to calm down her body and change her thoughts. Once she can stay calm and relaxed with imagination only, she moves on to real life attempts as described above.

A key to making exposure work is knowing that submitting yourself to the anxious situation will allow you to eventually overcome it. The temptation is to avoid anxious situations rather than learn to power through them. But it is the exposure to the anxious situation that helps a person learn to overcome it.