Exposure Therapy Is Hard for Introverts With Anxiety

Exposure Therapy Is Hard for Introverts With Anxiety Social Anxiety Disorder Coping Print Why Exposure Therapy May Be Harder for Introverts With Social Anxiety By Arlin Cuncic Arlin Cuncic, MA, is the author of Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder and 7 Weeks to Reduce Anxiety. Learn about our editorial policy Arlin Cuncic Updated on August 12, 2019 Social Anxiety Disorder Overview Symptoms & Diagnosis Causes Treatment Living With In Children Sean Malyon / Getty Images Social anxiety and introversion are not the same things,  no matter how much public perception may sway you to think so.   Differences Between Introversion and Social Anxiety People who are socially anxious may dread social and performance situations for days or weeks prior to them happening, avoid these situations in such a manner that it interferes with daily life (thinkâ€"afraid to go grocery shopping, attend a class, or even go outside of home), and generally have negative cognitions (in laymans terms,  thoughts)  about themselves and their abilities to navigate the social world. In contrast, the definition of introversion has nothing to do with being anxious, fearful, or self-berating. Introverts can be quite confident in their own quiet and low-key way. They may become easily overloaded by external stimulation, which can cause them to retreat from social situationsâ€"but its not to run to the bathroom and beat themselves up for all their social missteps. Rather, they might escape to  read a good book, be alone with their thoughts, or simply be content with quiet. It gets interesting, however, when social anxiety and introversion collide. Introversion and Social Anxiety Combined Imagine for a moment that no matter how hard you try, you just cant get yourself to like a certain food. Then also imagine that you happen to also be allergic to that food. You arent particularly bothered by the fact that you cant eat the food because anytime that you have eaten it, you havent enjoyed it anyway. Thats a bit how it is for those socially anxious introverts. They dont particularly  want  to be the life of the party, the social butterfly, or the late-night partier. They also may prefer a job that allows them to sit quietly all day pondering lifes deep problems rather than interacting with customers, giving presentations, or supervising others. At the same time, their natural desire to spend time alone makes it very difficult to expose themselves to the situations that cause anxiety. The question isâ€"does it matter? Motivation to Change Does it matter if you live in a cave and never leave  if you are more content inside the cave than you would be on the outside?   Susan Cain, author of the groundbreaking book Quiet would argue that we should nurture the introverts just as they are and provide them with supportive school and work environments.   In Eastern cultures, compared to Western cultures, more value is placed on reticent personalities, and gregariousness is not the norm. Are we expecting our socially anxious introverts to measure up to a cultural ideal that does not necessarily translate into success for them as individuals? Coping With Introversion/Social Anxiety If we tease apart the two parts of the equation, it may be easier to come up with an answer to this riddle. Because  we know what is needed for introversion and what is needed for social anxiety. It looks a bit like this. The introvert needs time away from social stimulation in order to gain energy. We dont fault the introvert for needing this downtime because it is understood to reflect a fundamental part of their physical makeup. As Cain points out based on her research, introverts experience stimuli more strongly, which is why they need to take a break. The person with social anxiety disorder, on the other hand, should not escape social situations in the same manner as the person with introversion, because when the anxiety subsides after having left the troublesome situation, the person believes that the only solution to rising anxiety is to escape. Butâ€"would the introverts overstimulation eventually subside if he just stayed in the situation long enough? More likely, his mood would deteriorate and his  functioning decline. So, if you are both introverted and socially anxious, remaining in those social and performance situations long enough that the anxiety subsides might be great for improving your social anxiety, but what about that pesky underlying introversion?   If you get to the point that giving a speech in front of your peers doesnt leave your hands trembling, mouth dry, and heart-pounding out of your chestâ€"but you still feel mentally drained after every presentation that you giveâ€"have you won? Can you ever be as comfortable onstage as someone whose neurological make-up has them seeking sensation at every turn? Career Paths and Introversion/Social Anxiety In fact, many actors claim to be introverts, such as Julia Roberts and Robert Deniro; that doesnt mean that they are also socially anxious, but rather that they prefer time alone and deep thought to casual conversation. On the other hand, there are some celebrities who inexplicably do fall into that category of person who is both introverted and socially anxious. The question naturally becomes, why did they choose the limelight if the limelight hurts their eyes? Zack Greinke is one example; a baseball player who knows that he thinks too much and has also been diagnosed with social anxiety disorder: Baseball is a sport where being stupid and keeping things really simple a lot of times is the right way to do things ...  there were guys I played with that were so stupid that theyre really good because their mind never gets in the way. Defining Goals to Define Treatment The answer perhaps lies in defining your life goals, dreams, ambitions, desiresâ€"and determining what you need to do to achieve them. Greinke wanted to be a professional baseball player in spite of his introversion and social anxiety. Do you want something so much that you would work against your natural nature to attain it? If the answer is yes, then you may have your why to explain the seeming conflict between your comfort zone and where you choose to place yourself. Getting back to the escape/avoidance example, is it possible to challenge your social anxiety while respecting your introverted nature? And do current treatment options take this into account? Or is it a one-size-fits-all approach to social anxiety treatment, whether your natural nature (minus the anxiety disorder) would be to dance at parties with lampshades on your head or sit quietly at the library while feeling calm. Perhaps this is even reflected in the fear hierarchies that we write? Fear Hierarchies Re-Evaluated If youve ever read a self-help book on social anxiety disorder, you will know that a fear hierarchy is a list of 10 or so fearful situations, progressing from least anxiety-provoking to most anxiety-provoking, which you must work through, either in-vivo (in real life) or in your imagination, either on your own or with the help of a therapist, until you are able to experience each event without experiencing distress or anxiety. Should the fear hierarchies of introverts and extroverts look the same or different? Are we all climbing the same ladder toward success? What do you define as success? A Homework Exercise for Defining Goals As an exercise in defining your goals, answer these questions for yourself in order to suss out what you truly need to achieve in treatment for social anxiety disorder: Do you consider yourself to be introverted, extroverted, or somewhere in the middle?What are your dreams, goals, aspirations, and hopes when it comes to your personal life?What are your dreams, goals, aspirations, and hopes when it comes to your career?Do these career and life aspirations match up with your natural level of introversion/extroversion? What you will notice about each of these points is that they have nothing to do with social anxiety itselfâ€"that is a given. If we start with the assumption that everyone entering treatment has a certain level of impaired functioning due to social anxiety, then the next step is simply to tailor treatment to ones level of introversion/extroversion. And this does not have to be difficult, it may just involve a few tweaks. Examples of Tailored Treatment Lets look at a few hypothetical examples: 1) Imagine that you consider yourself to be an introvert, who dreams of long one-on-one conversations with close friends, and a job as a museum curator involving detail-oriented work with some public interaction.   2) Imagine that you are an extrovert trapped by your social anxiety. You dream of doing stand-up comedy but feel queasy each time you step on stage. You are energized by the crowd but your social anxiety is holding you back. As you can see, the plan for exposure therapy may be quite different if you are an introvert or extrovert. The person in example one would likely have a fear hierarchy filled with social interactions  while the person in example two would be working through performance anxiety fears.   In other words, treatment for social anxiety can (and should) be tailored to your unique circumstances. Common Approaches This discussion, of course, leaves out medication treatment and other cognitive-behavioral therapy approaches such as disputing irrational thoughts, which would equally apply to both introverts and extroverts.   So the question remains: If you find yourself filled with social anxiety in a social situation as an introvertâ€"do you escape to honor your introversion or stay to challenge your social anxiety? Truthfully, you may have to disregard your introversion for a while, just long enough to build the confidence you need to overcome your social anxiety. Then you may be able to return to your little corner of the world and enjoy the quiet. Your struggle may be greater than those extroverts who will challenge their fears daily  because they simply enjoy being around people that much more. At the same time, remember that they are facing their own battles, living with two very disparate parts of themselves that must be in constant opposition. At least if you leave the party because of your social anxiety, your introversion will thank you for it.