This is another section for the SA CBT series. A lot of people quite rightly look at behavioural experiments (WHICH ARE NOT THE SAME AS 'EXPOSURE') and feel "how can I do that? I'm just too anxious!". This is totally valid and it would be foolish for anyone to expect an SA sufferer to go do the thing that terrifies him or her the most.
That is where the anxiety ladder comes in. Deleoped by Clark and Wells, its a fairly simple idea. Write down a list of all the things that SA stops you from doing, or situations that you know would be anxiety provoking for you. Try to think of EVERYTHING - dont just go for "making a speech" or "asking out the hottest girl in the bar" - we need that spread of all those things that defines your social anxiety disorder. Get a bit of paper and do it NOW... queuing at the checkout ... saying hi to someone at school ... smiling at a stranger .... inviting colleagues or friends out for lunch ... going into a store .... going into a nightclub .... Whatever it is FOR YOU, write them all down but make them practical
- "Get Britney Spears phone number" does not fit into this category ...
Now you have your list, you will hopefully see that there are ranges of things in there. There is stuff that is QUITE anxiety producing, MODERATELY anxiety producing, VERY anxiety producing and DEBILITATING. Re-order the list with the LEAST ANXIETY PROVOKING at the bottom and the MOST at the top.
This now becomes a template for doing the next stage - which is Behavioural Experiments (a later post)
This might seem obvious - I mean, why would you do the hardest stuff first? That would be silly right? Of course, you would want to start small. But the power of making the list is that you have generated LOTS of examples that cause you anxiety. You will need commitment to start the very first one, and that is why you should make it the easiest thing on the list. For example, one person used the example of crying at a sad movie at home alone, as even this made her anxious! Then she moved up to signing her name in front of someone. Her next one was getting on a swing with her children when they played. Then she went to open a bank account ... but because she started with what was the least anxious for HER, she felt a sense of accomplishment when she did it. Something in her mind said "hey - I can do this and it wasnt so bad!". As she did each item her confidence grew, little by little, like someone gradually cutting away the roots of a weed growing in a garden.
As she worked up her list, she was amazed to find that she had got to her most anxiety producing item of all - getting on a fast fairground ride and screaming - as she thought people would judge her badly. She did it, nothing bad happened and she really enjpyed the ride! She was elated, and made herself a NEW ladder with more things on it. The beauty of the ladder on paper is that it gives you a vidual reference of your progress and makes you try more things than you might do if it was only done in your head or unplanned.
If you do not know the PROPER METHOD for doing behavioural experiments, then for now just write out this list. I will put up a post soon on how to do the experiments.
You may wish to use the Liebowitz Anxiety Scale criteria, and your relative scoring, to construct you own Anxiety Ladder
See link at left
If even the very smallest thing terrifies you, then you may wish to start with visualisation or cognitive flooding'. This involves first getting yourself into a very relaxed state, perhaps via meditation or sitting comfortably in a quiet, undisturbed place and picturing a relaxing scene to make you feel calm. Really notice smells, sounds and textures and let yourself relax into it. Try to breathe evenly and deeply but not forced. Once at this stage, begin to picture the scene which is first on your list. Lets say it is going into a store without buying anything. If you have done the Attentional Training exercise, try to incorprate this understanding into the exercise too.
1) Picture the outside of the store you want to go in as if it were being filmed with a camera, in a detached way.
2) Now add some people walking in and out. See them going about their business, maybe looking in their shopping bag and smiling and thinking 'ooh I got some new shoes!' Picture other folk just kind of looking nonchalantly around the scene. Perhaps you can see folks through the window looking through racks of things.
3) Now imagine the camera swoops down, and slowly moves towards the door of the store. If you begin to feel anxious this is ok - just note it and keep breathing. See the doors open as the camera passes them, and then begin to 'fly' the camera around the store. Again notice the people looking at the racks, trying things on, maybe assessing if its worth the money or if it looks nice to eat. Notice how caught up in their actions they are. Do they look pleased? Confused? Are their kids bothering them? Perhaps they are a young couple on a date. What are they all interested in buying?
4) Make a full pass round the shop in this way and then go back to the front of the store. See the doors open and the camera passes through. As the scene ends at the front of the store, turn it round to see the view you started with. People just looking through racks, someone happily walking out with a product in their bag, involved in their own actions.
Perform the above, but this time make it like one of those computer games where there is a little charcter walking around the 3D world you saw in part A. This character is going to be you, and you are going to follow yourself around the store seeing all the same things as before, but you can see YOU at the same time.
1) See yourself at the front of the store. The camera swoops down past you. Your face looks relaxed, maybe expressionless or flat. See yourself walking with an upright back and posture through the doors.
2) Start on your journey through the store. In the background are all those same people, looking through racks, checking out prices, getting absorbed in their purchases.
3) As you enter you are thinking about your journey through the store, or perhaps what you might like to buy on the shelves. If its a supermarket, are there some nice apples or grapes? See your eyes looking for the grapes. As you walk past people in the store they continue about their business, engrossed in their cucumbers and pomegranates!!
4) Maintain the 3rd person view and see yourself with your upright posture and 'flat' face. You may even want to add a little smile at this point - because you're nearly there!
5) Walk past the couple who are giggling. As you look closer you see they have picked up some big grey briefs that are really ugly! ( ) they are giggling at them because the girls dad has a horrid pair the same! See yourself walk past, maintaining the same pace and expression, and looking around the items on display.
6) Follow the same route to the front of the store, and see yourself stop and turn. See the people looking at the racks or in their shopping bag. Notice how you are just part of the scene and others happily go about their business.
This is the big one! This time we are going to do it first person style!! Just like the computer games I want you to run part B again, but this time you are inside your own body.
1) At the front of the store, think about entering. Feel the weight of your body and be aware of all the sights, sounds and smells. If you feel anxious, let the feeling come. Dont fight it, just stay with the image and the feeling. It will reach a peak and then subside. Stay with it until it does and then enter the store.
2) As you walk around, feel the movement of your limbs. Feel the pressure of your feet on the floor as you take steps. Smell the fruit and vegetables or even the smell of wasjing powder. Hear the background ambience echoing around. Listen to people discussing the products. Maybe the occasional item falls and there is a brief 'crash!'. If you start to feel anxious, stop at that point in the journey, but STAY IN THE PICTURE, stay with the feeling and let it build. It will reach a peak and then subside. Dont fight it, just let it happen. Maybe even say to yourself "hey this is my film - and that doesnt happen when I'm in charge!" Once it has passed, carry on the journey watching others absorbed in their own business.
3) Keep looking around at the products and the shelves. How high are they? 5 feet? 10 feet? What colours are there? Are there announcements? Are there people refilling the shelves? Move all the way round being aware how others are interested in their products or just paying and leaving. Imagine that flat or nonchalant expression on your face and how you look around at the products. Let the people just fade into the background, even let them seem a little fuzzy as if they are extras in your film.
4) Make it to the front of the store and turn around! See the people looking at products or in their bags. You have done it!
Run this method a few times until it starts to feel automatic. It is best if you can use the REAL PLACE you want to go in. If you have never been in then perhaps walk by one day and get a vague idea of layout. If not then just imagine what you think it will be like - they key is just making it round! Once it feels natural and the objects, smells, sounds and people all just flow, its time to go and do the behavioural experiment.
And THAT will be the topic of my next post