One of the most frequent reasons people seek out therapy is to address their anxiety. Anxiety can be a debilitating condition in which it feels like your anxiety runs your life. Symptoms of anxiety include racing negative thoughts, a tightening of the chest, rapid heartbeat, difficulty staying present, lightheadedness, queasiness or stomach pain, and restlessness. One of the more common forms of anxiety is social anxiety, which is when someone has outsized, persistent fears about being exposed to possible scrutiny. This can look like anxiety about meeting new people, anxiety while having conversations, anxiety about being observed, and/or anxiety about your performance. The core fear of someone with social anxiety is that they will act in a way that is negatively evaluated by others; they might imagine being humiliated, offending someone, or may picture social rejection. 

One of the key factors that maintains any form of anxiety is avoidance. Avoidance tends to work in the short-term, that is we start to feel better when a feared situation is avoided because the parasympathetic nervous system returns the body to its normal, resting state. This brings feelings of relief and maintains the neural connection between the anxiety-provoking situation and the fear response. In contrast, when someone exposes themselves to anxiety-provoking stimuli and their feared outcome fails to come to fruition, the body slows down and has the chance to unlearn the connection between the stimulus and fear. This has an evolutionary advantage– as an example, the earliest humans needed to be afraid of the unknown, such as fire, but also needed to be able to overcome this fear in order to harness fire for warmth, protection, and cooking. However, unlearning the connection between an anxiety-provoking situation and fear requires us to ignore some of our most basic instincts, such as fleeing when our body feels like we might be in danger.

Research shows that one of the most successful treatments for maladaptive anxiety is exposure and response prevention (EXRP). This process involves purposefully putting ourselves in an anxiety-provoking situation (exposure), and avoiding the urge to respond by fleeing (response prevention). If someone can accomplish these two tasks for an extended time, say 45 minutes, the body has adequate time to return to its resting state and unpair the neural connection between the stimulus and anxiety. Purposefully putting oneself in an anxiety-provoking situation is no easy feat! Therefore people often create a hierarchy of fears, tackling first those which provoke the least anxiety and slowly moving up towards the fears that provoke the highest levels of anxiety. Luckily, if you live in New York City and suffer from social anxiety, there are ample naturalistic opportunities to engage in exposure and response prevention. 

Some of the beautiful things about NYC are its anonymity and saturation with interesting people. Most NYC residents go about their day witnessing something strange or unusual and carry on as if nothing has happened. Those who have had the pleasure of working in the service industry can attest to the sheer volume of unusual interactions they might have in a day, with little thought or attention paid to any one of these interactions. This can create a low-stakes environment in which to explore one’s ill-founded anxieties and create one’s own exposure opportunities. Sing out loud on the subway. Chat with a stranger about their favorite TV show. Ask a barista about their favorite drink to make. There’s a chance that you might get a funny look or maybe even laughed at, but you will have just survived the thing that scares you– and lived to tell the tale! Even the outcomes that sit at the heart of one’s anxiety are, in the grand scheme, not that bad. You will have just taken a positive step towards reclaiming your freedom and away from a life in which anxiety runs the show.