Train courage on small things

Meta-analysis of RCTs found assertiveness training (rehearsing low-stakes assertive acts like saying no / making requests) was superior to no-treatment and placebo for reducing social anxiety at post-treatment and follow-up. This is the closest formal analogue to 'practice courage on small zero-stakes interactions.'

RCT of CBT targeting assertiveness produced large reductions in social anxiety vs wait-list (ES ~0.67-0.93) by having participants practice graded assertive behaviors. Supports the mechanism that repeated small assertive acts reduce anxiety/avoidance.

Establishes the mechanism the method relies on: deliberately approaching feared/uncomfortable situations and acting despite discomfort drives inhibitory learning ('I feel discomfort and act anyway'), the active ingredient of exposure therapy. Notably, this literature shows the GRADED ordering itself (start tiny) is mainly for buy-in/compliance, not a proven mechanism — the doing-despite-discomfort is what matters.

CBT built on graded exposure (climbing a hierarchy from low- to high-stakes situations) reduced anxiety in autistic youth vs treatment-as-usual. Shows the exposure-hierarchy principle the method embodies is effective and adaptable in an autistic population — though it tests a full clinician-led program, not the self-directed micro-acts described here.