Shame, not low self-esteem, is often the hidden engine of social anxiety.

When shame is reduced, social anxiety is often dramatically reduced, too—or even eliminated.

We often dramatically overestimate how critical and judgmental other people really are.

Deliberately making a fool of yourself can be terrifying, and profoundly liberating.

Disclaimer: This article is nonfiction but describes events that happened many years ago. The dialogue and other details were reconstructed as accurately as possible from the author's memory.

A young man named Martin came to see me in Philadelphia for treatment of intense social anxiety. He explained that he sweated profusely—far more than the average person—and was absolutely convinced that if women saw how sweaty he was, they’d be totally grossed out and reject him.

He said he’d used every deodorant and chemical imaginable, but it made no difference. He described himself as a veritable sprinkler, with sweat pouring from his face, armpits, and entire body. He was so humiliated that he rarely left his apartment during the day and only ventured out at night to do his shopping.

He told me he’d had this problem since adolescence. Now in his early 30s, he had never had a date. He asked me if he was a “hopeless case.”

I was surprised, because to me, he seemed incredibly good-looking. That summer, my daughter was working as a receptionist in my clinic, so I asked her for a woman’s perspective. Was I imagining things?

She said, “Dad, Martin is in the category we call drop-dead gorgeous.”

So much for hopeless.

Around that time, I had learned about a technique developed by the legendary New York psychologist Albert Ellis for people struggling with social anxiety and shame. It’s called a shame-attacking exercise: a deliberate attempt to do something super-embarrassing in public in order to discover that the feared consequences never materialize.

When Martin asked if he was hopeless, I said, “No, social anxiety is actually my favorite problem to treat. But I have a different question. Can you afford the treatment?” He looked flustered. He asked if $125 a session wasn’t enough, or if there was a surcharge for severe anxiety.

I explained that money wasn’t the issue; courage was.

I said, “If you want me to treat you, you’ll have to agree to do exactly what I ask. And some of it may terrify you. I might ask you to do something called a shame-attacking exercise. That means making a fool of yourself in public on purpose. Would you be willing?”

He was so eager that he didn’t hesitate. “No problem,” he said. “I’ll do whatever you ask.” I scheduled our next session for two hours, from 2 to 4 pm, which is the hottest part of a Philadelphia summer day. He arrived early.

I told him we’d be having our session outside the hospital, but first we had to stop by the clinical lab to pick up a special piece of equipment. I grabbed a test-tube cleaner—basically a squirt gun with a curved spout—and filled it with water. Then I explained the plan: We’d jog half a mile to a nearby 7-Eleven. Between the heat and humidity, we’d get nice and sweaty.

Martin thought this sounded like a wonderful new form of therapy—just jogging and chatting with his psychiatrist.

When we arrived, I told him he was sweaty, but not nearly sweaty enough. I squirted water under his armpits and poured it over his head so the water ran down his cheeks.

Then I said, “Here’s the assignment. I want you to walk into the store, stand by the cash register, put one hand on your head, point to your armpit with the other, and say loudly: "Look at me. I think I’m the sweatiest man in Philadelphia. It’s so hot and humid today, I’m sweating like a stuffed pig!’”

At that moment, Martin realized what a shame-attacking exercise actually was. He flatly refused. He said it was impossible, humiliating, and horrible. He insisted that he’d make a total fool of himself.

I reminded him that he’d promised to do whatever I asked if I agreed to work with him. This was not negotiable. After several minutes of heated debate, he finally said, “If you think it’s so easy, Doctor, I want to see you do it.”

“Fair enough,” I said. I had him squirt my armpits and dump water on my head. Then I told him to watch from the doorway.

I walked up to the cash register, struck the pose, and loudly delivered the line.

No one cared. People grabbed their Slurpees, paid for their gas, and left. I might as well have been invisible. Martin was stunned. Then I said, “OK, your turn. No excuses now!”

He was terrified, but he did it.

The result was completely different. Because he was so handsome, people assumed it was some kind of commercial. They crowded around him, laughing and commiserating. Several told him they sweated too and asked if he’d tried this or that deodorant. Some asked what brand he was recommending, and if this would be for a television commercial!

This blew his mind. It was the exact opposite of what he had expected.

We went from store to store, taking turns with our sweaty armpit routine. Instead of criticizing or rejecting us, people were friendly and curious. It felt as if everyone was bored and happy to encounter something zany and fun.

Eventually, we wandered into a boutique filled with stylish women’s clothing. I noticed a young woman giving Martin the eye, but he didn’t see it. His mind was trained to filter out anything that contradicted his negative beliefs.

I told him to approach her and do the exercise. This time, he was adamant. Impossible. Horrible. Off the charts. He was sure she’d find him repulsive.

I said, “Martin, this is your final assignment. Once you’ve done it, you graduate with high honors. I promise I won’t ask you to do any more shame-attacking exercises.”

He approached her cautiously, struck the pose, and delivered his line.

She seemed pleased that he’d approached her, though she appeared slightly puzzled by what he was saying. Within moments, they were deep in conversation. After a few minutes, she said she had to head to Presbyterian Hospital for a doctor’s appointment, but wondered if they might get together for coffee sometime.

“That sounds great,” Martin said.

“Well,” she asked, “would you need my name and phone number so you could call me?”

“Yes,” he said. “That would help. I’m Martin.”

She wrote her number on a scrap of paper, placed it in his hand, and gently closed his fist around it. “Now make sure you don’t lose that, Martin,” she said, before walking away.

Martin just stood there, staring at his closed fist. He looked stunned. He’d just discovered that his flaws were not a barrier to love. His honesty and humility were possibly even endearing to the woman he met, and an invaluable asset that balanced his intimidating good looks.

Martin and I only met a couple more times after that. His social anxiety didn’t gradually improve—it vanished. Not because he stopped sweating, but because he’d embraced it fully and stopped hiding it in shame.

That’s the part most people don’t understand about anxiety. It isn’t caused by sweating, blushing, trembling, or saying the wrong thing. It’s caused by the belief that if people see who you really are, they’ll reject you. Martin tested that belief, publicly and with enormous courage, and discovered something life-changing: The monster he feared had no teeth.

Another lesson? Shame is like a vampire. It dies the moment it’s exposed to the sunlight.

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