Speech exposures can be a very useful tool when treating Social Anxiety Disorder (SAD) and may be used in other exposure therapy treatment plans as well. Speech exposures can be conducted with an audience of confederates or other patients/clients in the context of a group therapy setting. There are a variety of variables that can be easily manipulated to specifically target the likelihood or cost of a variety of feared outcomes including: audience size, speech topic, speech duration, the individual feigning symptoms/behaviors (e.g., mind going blank, sweating, lack of knowledge), audience members feigning reactions (e.g., negative judgement, boredom). Below are some useful tools for conducting speech exposures.

• Speech Exposure Feedback Questionnaire Example - This is an example of a questionnaire that can be used to get feedback from audience members after a speech exposure. The use of a feedback questionnaire allow an individual to gather evidence pertaining to their feared outcomes. In many cases, this provides an opportunity for powerful disconfirming evidence. The questionnaire can be customized to asses the specific feared outcomes an individual has that they wanted feedback on. Create your own questionnaire tailored to your patient/client's feared outcomes.
  • Tip: Ask the patient/client to complete the questionnaire rating themselves as well and then compare their ratings (often biased toward the negative) to the audience members to further highlight their likelihood/cost biases.
• Speech Topic Ideas - The topic of the speech can be selected strategically to target different feared outcomes whether its neutral topics, controversial topics, topics the individual knows little about, or personal topics. An additional variable to consider is whether the individual is aware of the topic they will speak on before the exposure exercise or if they will be told the topic at the start of the exposure exercise (the latter assists an individual with disengaging from over-preparing or rehearsal strategies). This list provides some ideas but are just examples!
• Speech Exposure Planning & Processing Form - This form aids in the planning and processing of a speech exposure by guiding the user to identify 1) at least 2 specific feared outcomes and rate their likelihood and cost estimates of those outcomes; 2) false safety behaviors they may turn towards; and 3) behavioral goals for the exposure exercise. The form also guides the user to reflect on what they learned and how that knowledge can be applied in future situations.
• Example Video: Reviewing Video Feedback: Recording an exposure exercise for subsequent review to gather additional data regarding feared outcomes is a useful strategy and often used within the context of a speech exposure. This video provides an example of how to engage a patient/client in reviewing video of an exposure exercise (such as a speech exposure). The video illustrates several key techniques, including: 1) identifying a patient’s predictions in advance of viewing a video; 2) preparing the patient to view the video; 3) discussing the video and rewinding to capture key moments; 4) comparing ratings before and after viewing the video; and 5) freezing the moment of disconfirmation and consolidating learning. For more details on using video feedback see the following article: Cognitive and Behavioral Practice. Volume 24, Issue 2, May 2017, Pages 245-255. Seeing Is Believing: Using Video Feedback in Cognitive Therapy for Social Anxiety Disorder. Author: Emma Warnock-Parkes, Jennifer Wild, Richard Stott ,Nick Grey, Anke Ehlers, David M. Clark. Publisher: Elsevier. Date: May 2017