Facing Social Anxiety with Graded Exposure

As somebody with Bipolar, I have always suffered with Anxiety, it had always been at a manageable level where I could control the panic attacks and shield myself from the worst of it. But last year it escalated to the point where I found myself unable to leave my home, or to even pick up the phone. I became afraid of my own shadow and I would go weeks at a time without even opening the front door or speaking to anybody but my Husband.

After being transferred into the Community Rehabilitation Team in December one of the targets we set was for me to overcome the social anxiety I had developed, it was decided that the best way to do this would be using a long term psychological therapy method known as Graded Exposure.

With Graded Exposure, you push the limit of your anxiety, face your fears, in a graded fashion, and keep a record of your work by rating your anxiety levels, each time your anxiety should drop a little as your mind and body get used to what you are doing and see there is no threat in the activity. Once your anxiety level has dropped by 50% you move on to the next level doing the activity you had planned would be slightly harder. You also do all this without any medication to help ease your anxiety, the idea is that you face your anxiety with nothing medical to ease the feelings.

There are four conditions you should follow when carrying out Graded Exposure, I’ve taken this information from the worksheet I was given when I was first introduced to the idea, it can be found on Page 10 of the information produced by the University of Exeter.

Condition 1: Graded List things in your exposure hierarchy that give you at least 50-60% anxiety from the easier things up to more difficult things. Remember not to grade an exercise by time. When you have been repeating an exercise and it no longer gives you at least 40% anxiety at the start of the exercise, you are then ready to move up to the next item on your exposure hierarchy.

Condition 2: Prolonged Stay in the exposure exercise situation, without using distraction until your anxiety drops by 50% from the start of the exercise. So for example if you were 80% anxious, you would stay in the situation until your anxiety drops to 40%. You would then repeat the exercise until it no longer gets above 40% at the start of the exercise.

Condition 3: Repeated Expose yourself to each step on the hierarchy at a time. You should repeat each step until the exercise no longer makes you feel anxious, say if it no longer goes above 40% anxiety at the start of the exercise. Then it is time to move up to the next exercise on your hierarchy ladder. On average you should aim to do exposure treatment 4-5 times per week (these may be different exercises depending on your ratings).

Condition 4: Without Distraction Try to remove things from your hierarchy that reduce your anxiety artificially or distract you from how you are feeling during your exposure exercises. Whist these may seem like the give temporary relief from feeling anxious, they are keeping you stuck in that vicious circle.

We started by writing out a plan of activities starting by easy one’s such as walking accompanied to the end of the street, and gradually building up to very difficult one’s such as taking the bus alone to the centre of the City. There were about 20 activities on the list, gradually increasing the difficulty.

It has taken us about six months of twice weekly working with my two Care Coordinators, additional sessions with my Peer Worker, and sessions on my own and with my Husband. This has been an all in approach that everyone has had to adopt. I’ve had some difficulties, and have had to go backwards a few times, but I am now only a few activities away from completing this list. It’s daunting as I’m now on the most difficult activities on the list, I’m doing the things I find the most difficult and scary. I can feel the anxiety creeping up on me constantly, but I’m so determined to get some kind of life back that I keep pushing myself.

Over the months, I’ve learned how to use breathing to manage anxiety when it suddenly hits me, how my posture when I walk makes a difference to how my anxiety can affect me, how if I pay attention to other people I can see that they aren’t actually paying any attention to me (one of my biggest anxieties is people are watching me).

I have also learned to be more honest with myself about how I feel, by doing this I can manage anxiety before it reaches panic level. I’ve learned to be more aware of what actually triggers my anxiety rather than thinking everything does. This way I know how to handle those particular situations better, and by talking them through with my Care Co-ordinators I’ve learned that some of those situations make everyone anxious and aren’t unique to me which have also made them easier to handle.

I was very cynical of Graded Exposure when it was first suggested to me, even when we first started it, I thought it had no hope of working, I was so full of anxiety that I couldn’t see how making myself feel anxious could possibly make me feel better, but it has worked, and I have been getting better. I have been able to leave the house and go for short walks alone. Last week I took the bus to my GP alone, the first time I’ve been on a bus alone for over a year. The concept of Graded Exposure has worked, it has been hard, exhausting, terribly upsetting at times but it has worked. Somehow.


2 thoughts on “Facing Social Anxiety with Graded Exposure

  1. Thank you for sharing your story. I cannot imagine how elated you must feel when you look back on how far you have come. Keep going – you are so strong and such an inspiration 🙂

    Liked by 1 person

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