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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.




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10 Comments

  1. Dear Steven j. Seay
    I have read a lot of literature on OCD but I can say that your above written article is unique. I am going to save it for future reading and practicing on it. I think tendency to control the uncontrollable is behind the OCD. It may be one of the main root causes of OCD if not the only one.By doing intentional mistakes one allows oneself to loose undue control.Acceptance of oneself including one’s faults also make a way to loose undue control so it helps in dealing with OCD or better say Obsessive Compulsive psychological Condition OCPC instead of OCD.There is undoubtedly a lot of similarity between Social Anxiety and so call OCD or OCPC as you mentioned.

    • You make a good point. Our fears often lead us to over-control situations in hopes that we can prevent our feared outcome from coming true. Only by giving up this control can we break free from the hold our fears have on us.

  2. Many thanks to this written work. I am in middle school and have Maladaptive Perfectionism, OCD, and Trich. I have the worst time challengeing it because I would have to affect my grades in order to get over it. I would rather be stabbed in the side than miss problems on an assignment, since I feel as if I have been stabbed ten times and doomed my future or someone else because of such a stupid mistake. I wish I didn’t feel that way. Thankyou for posting other ways to help me with my ERP.

    • Academic perfectionism can be challenging, and ERP certainly involves some risk-taking. However, the good thing is that treatment gets easier with practice; the first risks you take will be the hardest.

      I think it’s also helpful to keep the big picture in mind. In the long run, OCD is much more likely to keep you from reaching your future goals than any treatment-related “mistakes.” If your perfectionism goes unchallenged, it’s likely to make it difficult to complete assignments, meet deadlines, and succeed academically.

      It’s definitely your call, but make sure you consider the downside of avoiding mistakes.

  3. I was hoping for some information regarding Social Anxiety and “Sensorimotor” OCD. Not only am a plagued with many forms of the latter, I suffer intensely from the former. I’ve exhaustively tried all avenues of research and have discovered absolutely nothing about my conditions or why they are co-occuring. Although maybe I’m the special case here.

  4. Dear Dr. Steven Seay,

    Would posting anti-religious comments or pictures on facebook be too extreme of an application of ERP, or is it ERP at all knowing that a public apology on a facebook status is thought of due to the degree at which people would be offended?

  5. Verry nice article (ouch, I purposefully misspelled that!). I just found this on Google+, searching for “perfectionism.”

    I’m not OCD. For example, my office is in shambles. Cleanliness is a constant chore, and I’m not just being humble! On the surface, people would think I’m an A+ social guy, confident, accomplished, and on track.

    Inside myself, though…. I’m in shambles! I have extremely high goals and aspirations for myself. I am a very high achiever. But sometimes, I struggle getting out of bed in the morning. I’m my own worst critic. I don’t really have any other critics, really!

    I think I can do a better job of not taking myself so seriously. Seriously!

    Anyway, thanks for the post, and for the free advice!

  6. good article. We all have the freedom of looking and acting stupid; unless seriously harming others. Force yourself to do things that make you nervous. Talk to a stranger and say you like him/her, say your boss you don’t agree with him; do public speech; make mistakes; and see the consequences are not so bad at all. That’s what we call experience; and no try means no mistakes no experience no development. you draw a circle around yourself and keep belieiving you cannot step outside it. just give it a try and you’ll eventually beat your learned helplessness.

    cheers

  7. Hi Jeremy – ask yourself why your office is in shambles. If it is because it is too exhausting to put the paperwork away….ie very specific filing system, etc…you just might have OCD.

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