> Exposure therapy like Toastmasters seems to provide big short-term gains, but the effects fade fairly quickly, and if I don't do it for a few weeks I'm back

> Exposure therapy like Toastmasters seems to provide big short-term gains, but the effects fade fairly quickly, and if I don't do it for a few weeks I'm back where I started. I've never participated in a Toastmasters so take with a pinch of salt, but I'd theorise this is happening because you're tackling a symptom and not the cause. Toastmasters is conditioning you to be able to perform a pre-prepared speech, which is ok, but that's not the real issue here. I'd wager the true issue is that you don't feel comfortable or have confidence in your ability to adapt to situations that are impossible to anticipate or prepare for. I'd suggest taking improv comedy lessons as you'll naturally get used to becoming adaptive to whatever is thrown out there. You could also try playing DnD or some other table top role playing game because again, it's low stakes improvisation in a supportive environment and you can try on different characters and approaches and see what works for you.