When we experience high levels of anxiety in social situations, or have urges to avoid or escape, it is typically because we are worrying that other people will criticize or judge us. A feeling of intimidation and vulnerability may persist due to thoughts such as “What if they notice that I’m nervous ?, What if they think I’m weird?, What if they ask me why I’m shaking?, What if they say something about my anxiety?. Learning how to stand up and challenge criticisms and judgments that you worry about can greatly reduce your anxiety or your urge to avoid. A form of treatment for social anxiety called Assertive Defense of the Self (ADS), developed by Dr. Christine Padesky, is focuses directly on building assertive skills and strong self-confidence in handling the specific criticisms that you fear. The resulting confidence can bring rapid progress in expanding your life as you overcome your social anxiety.
ADS is accomplished initially through listing out the judgments you fear in writing, then developing specific assertive responses that could be appropriate in a variety of situations that may concern you. You then practice hearing/facing those criticisms directly (exposure) while responding assertively in repeated role plays. You have immediate opportunity for support and coaching by your therapist to help ensure you reach a high level of confidence that you indeed could handle those criticisms. You will likely discover that you can even defend yourself against what you worry people might think of you, or even against your own self-criticisms! This treatment can be very empowering and rapidly reduce anxiety as you literally discover, through repeated role plays of facing what you fear, that you are not helpless in those situations, and that you actually have the ability to handle just about any criticism or judgment that someone might have of you!
What is Assertive Defense of the Self (ADS)?
A sense of confidence that you would be able to cope, or self efficacy (Rotter, 1954, 1966; Bandura, 1977), is one of the highest predictors of avoidance versus taking action to face a situation. Without at least some basis of confidence about handling a situation, you can easily keep finding excuses to avoid or hold back, and you are not likely to have opportunities to disconfirm your worst fears about being confronted, or criticized, or humiliated.
Assertive defense of the self (Padesky, 1997; Padesky, 2020), like other leading forms of cognitive-behavioral therapy (CBT) for social anxiety, is empirically-based. It puts a primary emphasis on building a sense of self efficacy. ADS is somewhat less familiar in the literature thus far, but clinicians such as myself have used this approach for years and have seen great success, often in a relatively short amount of time. This approach can be powerful in reducing anxiety and intimidation not by trying to prove that people won’t judge you like you assume they will, but rather by focusing on how you can actually handle what the others might say or think of you in a confident, assertive way! This can embolden your efforts in the real world as you reduce anxiety and intimidation by increasing confidence in your ability to cope.
In assertive defense of the self you have opportunity to rapidly and succinctly build skills and confidence in handling your specific, even worst fears about criticism in a controlled, focused, gradual, repeated exposure process with coaching from your therapist. It allows you to quickly discover your ability to think and respond in a self-affirming way to whatever you fear could be said to you, or about you, or even what another might think about you. It facilitates experiential practice even in handling your own self-criticism.
The therapist and client can often accomplish a great deal in disconfirming the helplessness feelings (i.e. assumption) even in 1 or 2 therapy sessions. You can feel much more ready and willing to seek out social exposure opportunities, and in a more bold way. By starting with easier challenges and gradually working up to the worst criticisms you fear, with some prompting and coaching from a therapist, you can develop a confidence that you could handle even unexpected challenges, knowing you have faced and already had experience handling and coping with the worst ones you can imagine.
What might a therapist say or do in an actual ADS session? (some examples)
The following example illustrates the therapist’s potential role in 1) enhancing the exposure, and 2) coaching and prompting the client to consider ways they might respond. Note that the therapist does not “overcoach” or promote some perfect way of responding, but rather uses minimal support to facilitate a general sense that you could cope adequately, or “good enough”, with what you fear:
Therapist: Sarah, you’ve told me you are afraid people will notice your hand shaking and make fun of you. OK. I know this seems like the opposite of your typical inclinations, but would you experiment with me in saying…. Here, I wrote it down: ‘Dr. Shenk, please lean toward me and tell me that my hand is shaking, and put a little grin on your face like you are trying to tease me’. Go ahead, just try that out with me.
Sarah: But, I don’t feel like I would know what to say to that one! And I’d never ask someone to make fun of me like that!
Therapist: I understand, but would you be willing to just experiment here with me, remembering that we are working to get past your fear of this happening, to view it in a different way? (Sarah pauses, then nods affirmatively). Ok, let’s take a moment to prepare for assertive coping. What are some ways you could then respond to such a comment? What might be a way to maybe acknowledge that your hand does shake a little more than with other people, but then respond with an affirming statement about yourself, or with a little humor?
Sarah (with or without further coaching): I guess I could say ‘ Yeah, my hand does get to shaking sometimes, but it doesn’t seem to get in the way of anything.’ – How does that sound?
Therapist: Well, how might that sound, and feel to you? Shall we try that a few times and see how it feels? (Sarah nods.) Ok, first, ask me to lean in and tell you that your hand is shaking, and grin a bit. (Sarah states it, reluctantly, to the therapist).
Therapist: (leaning forward, with a little grin): So, look at you, your hand is shaking like a leaf! (Then stopping the role play for a moment). OK, now I’m going to repeat that with a little variation thrown in, and you can respond using your notes but trying to add any other responses that feel assertive, to experiment with how you could respond.
These exposures can eventually move up to directly role playing the worst of your fears, with the goal of leaving “no stone unturned” in the sense that you have faced the worst and had some success dealing with it. This can involve not only practicing responses to the criticism verbally, it can also involve forming a plan of coping with the results of the situation. With some assistance in coping ideas, can discover that indeed you are able to find adequate words and responses to deal with even strong criticisms or social experiences. For example:
Therapist playing critic: “You keep stumbling over your words. What’s wrong with you!”
Rolando (after some prompting and guidance): “I get a little anxious sometimes and can have a little trouble with my words. I think it’s just some left over anxiety reactions from my teen years that sometimes get triggered, since you asked. I happen to be working on that right now, which is why I’m out here talking with people as I am with you. But I assure you I’m quite normal in just about everything, I know you’ll see that if we get to know each other better. So, tell me more about yourself: How have you and your family been doing in coping with this dang pandemic going on for so long?”.
Therapist: “Great, you brought in a number of assertive responses! How did that feel to you, to be able to respond in that way?” (Discussion and debriefing.) “Now, a couple of variations that I believe might take us a step forward in building really strong confidence in hearing and handling criticism. I’d like for you try out a shorter version of responding, and to calmly pause and wait to see if the critic has more criticisms or comments to launch at you rather than rerouting the conversation so quickly. It might be helpful at times to know you can direct the conversation forward, but for now, just practice relaxing and allowing me to bring a next round of criticism. Does that make sense, as part of this exposure and mastery practice? (Rolando responds with understanding and willingness.)
Therapist: “You keep stumbling over your words. What’s wrong with you!”
Rolando: “I don’t believe there’s anything really wrong with me, I just get anxious sometimes in social situations”. I’m working on getting over that.”
Therapist: “So, like… you are fearful of people or something? That’s a little lame isn’t it?”
Rolando: (Out of role) “I’m not sure what to say to that. I’m feeling a little anxious here.”
Therapist: “Take a moment to reflect… What might make sense to say, if you feel good about yourself and are just handling the question in a light way, or you are just stating some facts about anxiety that don’t involve any judgments of yourself?”
Rolando: (out of role) “Ok, I’ll give it a go….” (Therapist repeats the previous critical response.) “Well, since you asked, I have a little anxiety about speaking in public, maybe from having to give speeches in high school. You know how that can go. So I’m just working now on getting out and talking more, to get over it.”
Therapist: “How did that feel, to respond that way?….”
A concise summary of the steps in ADS
- Elicit and identify the most feared criticisms (whether what people might say to me, or what people might think of me), and develop assertive, adaptive responses to each. Put these in writing, such as in a 2-column Criticism – Adaptive Response thought log.
- Conduct role play exposures with practice in assertive defense of the self, with debriefing and coaching from therapist (or other person, or yourself) as needed in varied ways of responding to the criticisms, including your voice tone, volume, posture, how much you do or do not say, levels of disclosure, or whether and how to bring in some humor. The role play or audio exposures to the criticisms would best be in a graduated way, starting with words and tones that are more low key at the beginning, but raising the challenge to increasingly more intense levels so that you are not left wondering whether you could handle more intense or challenging criticisms. Consult as needed on optimal ways to respond, drawing also from you own value system. Repeat the role play with coaching as needed until it no longer triggers much hesitation or anxiety in you. Keep written notes of the responses you find are most helpful, rehearse them but also keep in the mindset “There are ways of responding, I will be able to handle it” while being aware that situations will likely be somewhat different than rehearsed.
- Practice the exposures repeatedly between sessions in imagination, or by making varied audio recordings of the feared criticisms, then repeatedly practice responding to the recorded criticisms in various ways and with different volume or playfulness, etc. in your voice. Further, if you have a trusted friend or family member, you could ask them to record the voice so that you add variety or match the feared type of person (e.g. male or female) or tones that you had been dreading.
- A final step is to seize the moment and take action in the real social world to enter situations that you may have been avoiding, in particular ones that might trigger fears relevant to your recent ADS exposures in session (or at home with audio). This action can follow even 1 or 2 sessions of ADS practice, going out into real social situations where such a criticism might occur, and even hope (albeit with some understandable anxiety) for an opportunity that you will be able to actually practice your assertive coping. Put your prediction of how it will turn out in writing as a behavioral experiment to see whether and how well you were able to cope after all, and note how the other person responds to your response.
Advantages of ADS
CBT teaches and practices skills for coping and facilitates exposure therapy and behavioral experiments that can lead to tremendous progress. Some people, even with CBT, continue experiencing significant social anxiety because their various exposure efforts still have not brought opportunity to face and cope with some very specific feared judgments, criticisms or scenarios, or they believe they did not cope well when situations or criticisms did arise. They may continue to believe that they are incapable of challenging the judgments they assume others are having about them (mind reading) with thoughts such as “Maybe I got lucky that they didn’t notice me this time, but what if next time they do? What if someone else wasn’t as understanding as they were? What if they did say something and I wouldn’t know what to say?” or “What if they are thinking that of me and just didn’t say it out loud?”
ADS explicitly provides opportunity to experientially face those fears that are not so easy to encounter in real life, and to have almost certainty -with the help of your therapist – that you discover ways to cope with what you worry could happen. We can construct exposure to feared thoughts of judgment that you may assume could be occurring, including ones you think the other might not ever say in front of you, and then opportunity to challenge those feared thoughts in the context of also having some emotion activated by the role play. Role plays allows you to more vividly imagine, actually hear expressed in a real voice, that which you might not be able to face and conquer in real life, or an assumed judgment you think others might be having of you that they don’t say. This can be much more powerful than just doing a thought record alone, and helps ensure your use of adaptive responses to automatic thoughts are being employed while “under the influence” of strong emotion.
In ADS you hear and experience yourself finding words to use, and responding in an assertive, confident voice, when an actual feared criticism is launched at you.
Consider the following in imagination: How might your anxiety go down and confidence go up by the 7th or 12th time of hearing the same criticism in a 5-minute period, compared to the 1st delivery of that criticism? And, how much might anxiety levels change if you practiced, revised, and practiced again and again some assertive responses to the criticism in that 5-minute period? Might you feel more prepared and willing to go out and enter social situations?
ADS also provides, in the early sessions or pre exposure practices, opportunity for immediate debriefing and coaching by a therapist that can repair and rebuild confidence rapidly rather than allowing time for negative thinking and self-criticism to set in or discourage you after a social experience. For example, the therapist can help evaluate evidence regarding your automatic thoughts after the simulated encounter, or encourage you to immediately repeat the exposure and experiment with small but important changes such as a louder voice, a friendly smile, or using assertiveness techniques with head held high. Those corrective opportunities help to to quickly override or disprove a sense of failure or helplessness. Further, the therapist can help support and integrate acceptance principles, through integration of mindfulness for example, recognizing opportunities to practice acceptance with feeling embarrassed, or losing a relationship, reminding you of the greater good that comes from your persistence in efforts to expand your life socially.
Finally, as in cognitive-behavioral therapy (CBT), it is helpful to practice other adaptive responding to the feared criticism scenarios and possible social experiences. For example, if you asked someone on a date and they were not friendly in responding to you, you could practice walking away while hearing the therapist (or audio recording) recite aloud the anticipated self-criticisms you identified together as an exposure. You will practice assertively defending yourself in response to these self-criticisms, focusing for example on your own positive strength demonstrated in having been willing to boldly approach someone. This gives you experiential, positive practice in supplanting the negative dialogue that otherwise might emerge in your mind.
Keeping your eye on the ADS objective
The overall premise and goal in ADS is that as you repeatedly practice facing the most feared criticisms or social scenarios (exposure) in session, with prompts and coaching as needed, you discover that you do have ways to respond, you feel empowered with enhanced self-confidence and assertiveness skills, and the dread and avoidance is reduced based on actual experience handling what you fear. ADS does not diminish the likelihood or need for that essential next step of “real world” exposures, but it can greatly enhance willingness and readiness to push through anxiety and do more bold exposure work in the field. And the immediacy of feedback and opportunity to repeat the exposure to the perceived criticism will facilitate rapid integration of positive learning. This is likely because ADS directly and rapidly contributes to revision of self-efficacy beliefs, with greatly improved conviction that: 1) there are ways to handle just about anything that might arise, and 2) I am actually capable of responding to just about any comment or judgment that might be made of me.
Can I do ADS on my own, without a therapist?
And yes, you may be able to do these steps above on your own without a therapist, although it may not be as effective or reliable as with a trained therapist. You could create your own audio or video recordings of the critical voice, starting out with low key exposures then moving up to more intense or intimidating ones. IF you have a trusted friend or family member who would collaborate in a following the guidelines of ADS, starting out mildly, then gradually increasing the intensity of the exposure voice, tone and expression style only with your declaration of readiness for a higher level, that role play with another person might be effective. You would certainly want to educate them first regarding the steps and process, and your preferences. There is some risk that the other could overdo the process and that your relationship could be strained by such role play exposures, so caution is advised.
If you find yourself stuck in some form of avoidance, or you are dealing with unique circumstances, or just do not think you can do it on your own, I would encourage you to seek out a CBT therapist who is willing to work with you using or trying out the ADS approach or ask your current therapist if they would be willing to try this approach in your therapy. They might be encouraged to read the description in Padesky (2020) The Clinician’s Guide to CBT Using Mind Over Mood (2nd Ed.) and view the video under For Clinicians in this NSAC website, titled Christine Padesky, Ph.D. Discussing Best Practices for Treating Social Anxiety. They might also seek consultation with a therapist who has extensive experience using ADS.
Final Note: You may be surprised, as I have discovered with many of my clients over the years, at how rapidly and effectively you gain a sense of boldness and see progress toward recovery from your social fears by consistent use of the ADS approach.
Written by,
James L. Shenk, Ph.D.
NSAC – San Diego
References
Bandura, A. (1977) Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.
Clark and Wells (1995). A cognitive model of social phobia. In: R. Heimberg, M. Liebowitz, D.A. Hope, & F.R. Schneier (Eds.) Social phobia: Diagnosis, assessment and treatment (pp. 69-93). New York: Guildford Press.
Padesky, C. (1997). A more effective treatment focus for social phobia? International Cognitive Therapy Newsletter, 11 (1), 1-3.
