The Shyness & Social Anxiety Workbook
234If treatment has been less effective than you would have liked, this is a time to ﬁgure 
out why. Here are some possible reasons to consider:
UÊInadequate dosage . Typically, we think of dosage in the context of medica -
tion treatments, and certainly an inadequate dosage of medication (taking 
too little medication or taking medication for too short a time) can lead to 
a lack of improvement. However, the term “dosage” can also be applied 
to cognitive behavioral strategies. There is evidence that improvement is 
directly related to the amount of homework a person completes. So, if your 
exposure practices are too short or too infrequent or you don’t practice 
challenging your anxiety-provoking thoughts, your anxiety may not have 
improved as much as you had hoped.
UÊStress . If you were under a lot of stress while working on the strategies in 
this book, you may have found only limited beneﬁt. For example, if you 
were working very long hours, dealing with family stresses, or coping with 
serious health problems, you may not have been able to devote as much 
time to this treatment as you might have liked. Our recommendation is to 
try again once the stress in your life has subsided. Stress can also lead to a 
return of fear, an issue to which we will return shortly.
UÊOther psychological problems . In some cases, shyness and social anxiety 
are part of another problem. For example, someone with an eating disor -
der may have high levels of social anxiety for fear of looking fat in front 
of others. Although the strategies in this book may help in such a case, it 
would also be important to directly address the eating issues.