Table 1.

Social Anxiety Exposures (“Brave Challenges”) From www.bravepracticeforkids.com and Possible Modifications for COVID-19 Therapy Provision

Original exposure	Suggested modifications2
Goal of exposure1: Practice tolerating embarrassment or “bothering” someone else
Pick out a silly hat and run some errands.	Ensure errands are necessary (e.g., at grocery store); wear a hat during an online call or while taking a socially distanced walk; wear a “silly mask” instead of a silly hat.
Pick out a few silly tongue twisters, find three people to read them to (quickly).	Complete over video or phone with family or friends.
Watch videos of people doing embarrassing things or being embarrassed.	Share screen over telehealth platform to watch together.
Drop a giant bag of coins in a hallway, lobby, or waiting area and then pick them all up (Bonus if there are others around).	Drop bag of coins outside of a building, rather than inside.
Read a poem to a stranger; make it harder by making three mistakes on purpose.	Bring in novel people (e.g., fellow clinicians) onto the telehealth session to facilitate practice; send a text message containing mistakes to a friend or acquaintance.
Sing “Happy Birthday” as loud as you can in the middle of the lobby.	Sing “Happy Birthday” as loud as you can outside in a semipublic space while maintaining social distance.
Open a closed door in the clinic without knocking.	FaceTime someone without scheduling a time to chat in advance.
Pick a tasty snack and practice eating in front of someone you would normally avoid eating in front of.	Encourage a “lunch playdate” where youth eat over Zoom or a socially distanced picnic outside with a peer or family member.
Push on a pull door repeatedly.	None needed (can encourage hand sanitizer or use of a glove if a public space).
Answer a question incorrectly in class.	Potentially none needed; play a difficult trivia game virtually with clinician or with family.
Eat your snack in front of the clinic staff.	Eat a snack in front of clinician during telehealth session.
Do something embarrassing in front of peers at school (e.g., trip and fall, drop books on floor).	Send silly selfie to a peer via Snapchat; do something embarrassing during a video call.
Goal of exposure: Practice asking something of someone or “bothering” someone else
Send a text to a friend (Bonus: Immediately text to say it was an accident).	None needed.
Wear glasses on your head and ask someone if they have seen your glasses (or phone).	Practice doing so with a mask and maintaining social distance.
Prepare a 1-minute presentation on a topic of your choice to give to a few people.	Present over video or in front of family (or both).
Sit with people you do not know well in the cafeteria.	Will vary based on school restrictions. Can encourage outdoor picnics with peers when feasible.
Ask the teacher for help after class	Ask the teacher for help over video platform.
Call a friend to invite him or her for a playdate.	Call a friend for a socially distant playdate or a video playdate.
Order a cup of coffee or small object from a store—make it harder by telling the store clerk your order is incorrect or you want to return for something else.	Encourage ordering at a location with some type of outdoor location to maximize safety (while wearing a mask); instead of returning can add an item or ask for water.
Go to a local bookstore with a help desk and ask for a book recommendation.	Call a restaurant and ask for a recommendation on what to order; call a library and ask for an e-book recommendation.
Place an order for takeout by phone and say you changed your mind and do not want it anymore (Bonus: Add or change an item you ordered!).	None needed.
Ask for help (e.g., the time, a pen, directions) at the clinic front desk.	Call clinic to ask about appointment details (e.g., time, delivery method) (Bonus points if silly question).
Goal of the exposure: Practice tolerating social uncertainty
Pick random topics out of an envelope and speak about them for 1 minute to three or four people.	Bring in novel people (e.g., fellow clinicians) onto the telehealth session to facilitate practice.
Ask someone a hard question they probably will not know like “How many miles are between Las Vegas and the North Pole?”	Bring in novel people (e.g., fellow clinicians) onto the telehealth session to facilitate practice or ask friends of their parents over the phone.
For older youth—post a picture on social media that might not be perfect or cool.	None needed.
Start a conversation with someone new; make eye contact with peers in a hallway.	Send a text message to an acquaintance; for increased difficulty, FaceTime an acquaintance.
Attend an anxiety-provoking social event.	“Attend” a group video chat or a virtual social activity (e.g., youth group meeting; Bonus if you arrange the group video chat).
Goal of exposure: General social practice and skills opportunity
Go to a location with lots of people and tell 5–10 strangers you are doing a survey about their favorite ice cream flavor.	Bring in novel people (e.g., fellow clinicians) onto the telehealth session to facilitate practice or utilize friends of parents over the phone.
Ask someone in your building for directions to the train station.	Ask someone in a grocery store where the bread is located (while wearing a mask); call a store and ask about hours or COVID-19 protocols.
Say hello to someone new with eye contact.	Encourage practice outdoors with a mask on, making eye contact; encourage having video turned on for classroom activities.
Engage a new person in a conversation—practice on starting and continuing and exiting.	Have conversations with novel people (e.g., fellow clinicians) in teletherapy; arrange phone calls with unfamiliar friends of a caregiver to practice conversation.
Have a neutral conversation with a stranger in the elevator or grocery store line.	Practice neutral conversations in other contexts: ordering food on the phone, calling a store to ask about hours, scheduling an appointment.
Order by yourself in a restaurant.	Be in charge of ordering takeout for the family over the phone (not through an app) or call and ask what is on the menu.
Join age-appropriate clubs and organizations (e.g., sports teams, art class).	Join virtual clubs, or engage in virtual classes (e.g., dance, yoga, Karate, art).
Have one-on-one or small-group playdates.	Connect with other kids virtually, or in an outdoor space. With appropriate consent, facilitate connecting several socially anxious clients of similar age.

¹There is overlap in which exposures fall under which category, as exposures may be able to target more than one core fear simultaneously. Categories are presented as a guide for the types of modifications that might be made considering the primary goal of the exposure.

²Allowing clients to use safety behaviors initially and then repeat the same exposures while gradually pulling back safety behavior use can be one strategy for titrating the intensity of the exposure.