Facing a fear of looking anxious: step ideas
Step ideas to choose from with your therapist for facing a fear of looking anxious, from showing signs to small slips. Based on Clark and Wells (1995), Warnock-Parkes et al. (2017) and Craske et al. (2014): a list of graded practice ideas for fear of looking anxious, with safety behaviours to drop and steps to carry to the exposure hierarchy.
Written by Tarun Vermani, Trainee Clinical Psychologist Updated
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Facing a fear of looking anxious: step ideas
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How facing the fear helps
When you fear others will see you blush, sweat, shake or go blank, it makes sense to hide the signs or avoid being seen. But hiding and avoiding stop you finding out what people really notice. Hiding can make you more aware of yourself, and sometimes makes signs easier to spot.
Each step on this sheet is a chance to test what you fear, for example that people will stare or think less of you. Before a step, you and your therapist write down what you expect to happen. Afterwards, you write down what did happen. Your anxiety does not have to go down before you start or before you stop: what matters is finding out, with your attention on other people, not on yourself.
Practise each step more than once, and vary it: a different time, place or length.
Only practise steps you have agreed with your therapist, and leave out anything that would put your health or safety at real risk.
Letting signs of anxiety show
These ideas let the signs you usually hide be seen. They run roughly from easier to harder, but what is hard differs from person to person.
Pauses and small slips
These ideas test what happens when a conversation is less than smooth. Choose ones that fit you.
Finding out how you come across
These ideas help you check your picture of yourself against what others actually see. Some are done with your therapist.
Safety behaviours to drop
Safety behaviours are things you do to feel safer, like gripping your cup or avoiding eye contact to hide the signs. They can stop you finding out what really happens, so dropping them is part of each test. Tick the ones you use.
Choose which safety behaviours to drop with your therapist. Keep precautions that protect your real health or safety. Do not stop or change any prescribed medication on your own; talk to your prescriber first.
If you drink heavily most days, or take benzodiazepines (such as diazepam) or opioids, stopping suddenly can be dangerous. Talk to your GP or therapist before you cut down or stop.
Steps to add to my ladder
With your therapist, write down the steps you would like to try and what you fear will happen in each. Then rate how anxious you expect to feel, from 0 (no anxiety) to 100 (the most anxious you can imagine).
You and your therapist will add these steps to your graded exposure hierarchy, where you rank them and plan your practice.
| # | Step I could try | What I fear will happen | Expected anxiety (0 to 100) | Actions |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 |
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When to use ‘Facing a fear of looking anxious: step ideas’
‘Facing a fear of looking anxious: step ideas’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for social anxiety.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 15 minutes. It moves through six short steps:
- How facing the fear helps: When you fear others will see you blush, sweat, shake or go blank, it makes sense to hide the signs or avoid being seen. But hiding and…
- Letting signs of anxiety show: These ideas let the signs you usually hide be seen. They run roughly from easier to harder, but what is hard differs from person to person.
- Pauses and small slips: These ideas test what happens when a conversation is less than smooth. Choose ones that fit you.
- Finding out how you come across: These ideas help you check your picture of yourself against what others actually see. Some are done with your therapist.
- Safety behaviours to drop: Safety behaviours are things you do to feel safer, like gripping your cup or avoiding eye contact to hide the signs. They can stop you…
- Steps to add to my ladder: With your therapist, write down the steps you would like to try and what you fear will happen in each. Then rate how anxious you expect to…
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, ‘Facing a fear of looking anxious: step ideas’ works by gradually and safely facing avoided situations so anxiety can subside (exposure). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Craske, M.G., Treanor, M., Conway, C.C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23. doi:10.1016/j.brat.2014.04.006
- Clark, D.M., & Wells, A. (1995). A cognitive model of social phobia. In R.G. Heimberg, M.R. Liebowitz, D.A. Hope, & F.R. Schneier (Eds.), Social Phobia: Diagnosis, Assessment, and Treatment (pp. 69-93). New York: Guilford Press.
- Warnock-Parkes, E., Wild, J., Stott, R., Grey, N., Ehlers, A., & Clark, D.M. (2017). Seeing is believing: Using video feedback in cognitive therapy for social anxiety disorder. Cognitive and Behavioral Practice, 24(2), 245-255. doi:10.1016/j.cbpra.2016.03.007
- Clark, D.M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., Waddington, L., & Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 568-578. doi:10.1037/0022-006X.74.3.568
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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