OCD perfectionism & social anxiety treatment: Tweet your way to greater health

Intentional mistake practice (CBT) for social phobia, perfectionism, OCD

“Intentional Mistake Practice” can be used to challenge the problematic perfectionistic beliefs that are core to social anxiety and OCD.

Looking for ways to overcome social anxiety or OCD-related perfectionism?  At the end of this post, you’ll find some strategies I use to help individuals in South Florida (Palm Beach, Fort Lauderdale, Boca Raton, Boynton Beach, & Miami) overcome their anxiety.  These exercises are examples of “Intentional Mistake Practice”, a CBT-based technique that can be used to challenge some of the problematic perfectionistic beliefs that are central to social anxiety and OCD.

First, though, what do social anxiety and OCD-related perfectionism have in common?  Although on the surface, these anxiety disorders are quite different, individuals with social phobia and OCD often share many perfectionistic beliefs about the world.  Social anxiety (or “social phobia”) is characterized by excessive worry about being perceived negatively by others.  Individuals with social phobia often have perfectionistic expectations about their own behavior and question their social competence.  They fear potential shame, embarrassment, or rejection in social settings.

In OCD, perfectionistic cognitions may also involve “performing” in front of others but more often involve personal perfectionistic standards.  These individuals often feel a moral imperative to live up to their true potential.  They often seek to give nothing but their best (100% of the time) and fear making mistakes because of what this might imply about their value as a person.

Many research studies have found that the most effective treatment for OCD-related perfectionism and social anxiety is cognitive behavioral therapy (CBT).  If you have one of these conditions, find a therapist who uses exposure and response prevention (ERP), a specific form of CBT that will be an important part of your recovery.  ERP will help you challenge your perfectionistic beliefs, which will reduce your symptoms and make you less vulnerable to future relapse.  I should note that although ERP is commonly thought of as an OCD-specific intervention, its principles apply readily to social anxiety treatment.

As I have discussed earlier, ERP has two main components:

  1. exposure – purposely doing activities that are designed to elicit your anxiety
  2. response prevention – actively resisting the urge to complete a ritual

You should only complete exposures if you are able to maintain good response prevention while doing so.  This applies both to external/behavioral rituals, as well as mental rituals.  Even the most challenging, high-level exposures will be ineffective if you are not maintaining good response prevention.  Moreover, ritualizing during your exposures will actually strengthen your anxiety in the long run.  In some cases, acting in a self-deprecating manner or offering unnecessary apologies is actually a sneaky ritual that provides reassurance and maintains anxiety over time.  Eliminate these behaviors when you’re completing an exposure in order to maximize your treatment gains.

Completing exposures without ritualizing will help you (and your anxiety!) learn emotionally what you already know intellectually: “It’s okay to make mistakes.  No one is perfect, not even me.”

The nine exposure ideas discussed below are based on “intentional mistake practice” and utilize social media (Twitter, Facebook) to help you challenge perfectionistic beliefs and fight your anxiety.  Remember that exposures are supposed to make you feel anxious and uncomfortable.  If they were not challenging, they could not make you stronger.  If you feel anxious and you resist the urge to ritualize, you are actually weakening your anxiety.  Useful coping statements during these exposures might include:

  • No one is perfect.  Everybody makes mistakes.
  • This feels like a bigger deal than it actually is.
  • Anxiety is temporary and will pass even if I don’t ritualize.
  • These types of situations happen all the time.
  • When I feel anxiety during an exposure, it means I’m doing something to make myself stronger.
  • I’m not a mind-reader and don’t know what other people are actually thinking about this.

Nine Social Media-Based “Intentional Mistake Practice” Exposures

1. Make a status update or send out a tweet that contains a typoe.  In order to practice good response prevention,  you should not correct (or apologize for) the typo.  Let it stand on its own.

2. Post an unflattering picture of yourself online.  Resist urges to offer excuses or explanations about why the picture looks the way it does (e.g., “I just woke up” or “The photographer caught me by surprise.”).  Make sure that you do not make any self-deprecating comments.

3. Friend someone on Facebook you don’t actually know.  Because following strangers on Twitter is commonplace, this exposure is most effective when completed on Facebook.  Make sure that you don’t preemptively include any explanations or justifications for your friend request.

4. Make an off-topic comment.  Again, resist urges to offer explanations or “connect the dots”.

5. Make a post or send a tweet without checking it for typos.  This exercise is response prevention at its core and can increase your tolerance for doubt and uncertainty.

6. Share a link that doesn’t actually work.  Resist urges to correct the mistake or apologize.  If someone asks you for the correct link, send it to them privately without offering additional explanation.

7. Ask a question that has already been answered.  Make sure that you don’t offer explanations or apologize after the fact.

8. Comment on a stranger’s post.  Embrace the uncertainty of not knowing how/if they will respond.

9. Tell a lame joke with a “straight face”.  Even online, there are ways to “give away” the fact that you’re doing an exposure.  Keep that information to yourself to avoid “un-doing” the exposure, so that you can maximize your benefit.

Thoughts?  Other ideas for social media-based exposures?  Let’s discuss below.

…or continue the discussion on Facebook, Twitter, or Google+.