Social anxiety disorder

[buddy28]

Firstly, don’t listen to the people on the thread suggesting psychotropics aka meds are a long term cure for social anxiety disorder.

In 99 out of 100 cases, meds will not cure social anxiety because social anxiety is largely caused by a persons thoughts and beleifs. Medication changes neuronal chemistry, but so do thoughts and belief systems. If the belief systems which largely cause the perpetuation of social anxiety symptoms are not addressed, meds only become a temporary solution.

Clinical research and practical experience has demonstrated many anxiety disorders, including social anxiety, are most effectively treated using cognitive behavioural therapy specialized for the particular anxiety disorder.

Why arnt many mental health care professionals aware of this?

1) not alot of physicians and mental health care workers are intimately familiar with social anxiety disorder and associated effective therapeutic techniques because Social Anxiety is relatively newly classified as an 'official' mental disorder. Meaning appropriate treatment regimes for social anxiety have yet to become 'common knowledge' in the mental health care community, even though the clinical research is out there.

2) disappointing as this may sound, many mental health care workers and physicians regard social anxiety as a relatively benign mental health care problem having similar severity to the social unease many nonanxious people feel. Unfortunately, the name social anxiety employs a term which many nonanxious people associate with temporary social nervousness they occassionally experience. Thus, they erroneously assume social anxiety disorder is another case of the mental health care community pathologizing a relatively normal human condition. I try to explain to people who think this way, if non anxious people experience about a 4 or 5 anxiety level associated with a particular anxiety causing situation, social anxiety sufferers experience about a 25 or 30!!

3) because of the largely biological educational paradigm most physicians and psychiatrists are indoctrinated with and North Americans obsession with the 'quick fix', psychotropic medications are routinely overprescribed to social anxiety sufferers and pharmaceutical medications are usually emphasised as the singular most important aspect of the Social anxiety treatment regime. This has been proven false. But many health care workers attitudes remain unchanged simply because they may not be aware of more effective alternative treatment methods, underestimate the severity of the problem and assume an antidepressant will be sufficent to boost the patient out of their perceived 'low mood'....

4) and this is going to shock some of you. There are many doctors, psychologists, and psychiatrists out there who aren’t completely dedicated to their patients recovery. Pulling back the veil, many are just ordinary people like u and me who have lost their idealism that motivated them to pursue a profession in patient health care, that are now simply chasing the dollars, the women, or the status. Some really don’t care all that much and are too busy living behind the prestige of 'doctor' or 'psychiatrist'. This also does a good job explaining why many mental health care professionals aren’t up to date on the most effective therapies for disorders they treat.


So, what can i recommend. First, abandon the idea medications will cause social anxiety to go away. They most likely will not. Yes, they can add temporary relief and medications can be an effective adjunct to more effective long term treatment strategies, but they will not cure you.

Secondly, comprehensive cognitive behavioural therapy specialized for social anxiety has been empirically demonstrated as the most effective therapeutic strategy to overcome social anxiety disorder.

The great news is people overcome social anxiety disorder everyday using CBT, and so can you! Social anxiety, although extremely paralysing and restrictive, can be successfully treated using CBT.



If your serious about wanting to overcome social anxiety, I recommend you visit this website:

http://www.socialanxietyinstitute.org/



The Social Anxiety Institute located in Phoenix Arizona, is run by Dr Richards - a psychologist who specializes in treating social anxiety disorder whom had social anxiety himself for over 20 years before overcoming it and earning his PhD in psychology.

In response to the lack of publically available effective SA treatment regimes and knowledgeable mental healthcare professionals, Dr Richards created a 20 audio tape series and booklet which details cognitive and behavioural strategies required to overcome sa. Basically, the audio series and the book teaches u how to become ur own psychologist.

Dr Richards also runs international and national Social Anxiety behavioural therapy groups regularly from the social anxiety institute. He is a man dedicated to helping people overcome social anxiety.

My story. I’ve had social anxiety since I was 14-15. I’m 25 now. At one time my social anxiety was so debilitating I could barely talk to my own parents without feeling extremely embarrassed and anxious, let alone leave the house to buy some toothpaste or get a movie!! My social anxiety did a great job at restricting and limiting my choices in every aspect of my life, leaving me paralysed, depressed and feeling hopeless.

After buying Dr Richards 20 audio tape series and working on it for over a year (yes, its completely worth the money), I’m ALOT better. The severe depression is gone. I feel significantly less anxious and much more confident then I did 2 years ago. One of the great things, I don’t feel that ubiquitous panic anymore, fearing every social interaction will go horribly wrong.

It is a journey of self discovery. I’ve still got a ways to go, but at least now I’ve got the tools to get better.

 

[biteme]

There is a big debate on this topic with most doctors now recongizing that therapy alone is insufficient to improve most of these disorders for most people.

 

[casavant]

There is a big debate on this topic with most doctors now recongizing that therapy alone is insufficient to improve most of these disorders for most people.

Funny how some things that seem so obvious take such a long time to be recognized by the scientific and medical communities, huh? Honestly- this shit seems like a no-brainer. But then, it took a long time for them to admit that steroids enhance strength and muscle mass. I guess we shouldn't be surprised.

 

[buddy28]

Re: Re: Social anxiety disorder

You should talk to buddy28 who has had success treating SAD with cognitive therapy.

still reluctant to pick up that new fangled cognitive therapy?

 

[Fonz]

Zoloft and Paxil can cause some nasty sides. Xanax can be helpful but it can also cause trouble thinking clearly (like doing math). Of those three, Xanax seems to be the lesser of evils for negative sides though. Sometimes you will have to start out at a higher dose, then as your SAD calms down, you can lower the doses, sometimes to the point of taking a half on an as needed basis instead of 3 times a day. It's a short acting drug which is nice...no sense in taking something if you don't really have to. I wish you luck in finding what works for you!

Oh yeah.

Xanax and math don't mix.

I got so slow......doing math. Its stopped once I got off Xanax(I use it for sleep).

Fonz

 

[musclebrains]

Re: Re: Re: Social anxiety disorder

still reluctant to pick up that new fangled cognitive therapy?

I am more convinced than ever that it's no more effective than other forms of therapy. I supervise several psychologists who have given up on it. I wrote some articles critical of it recently, received an avalanche of mail from angry clinicians who claimed empirical evidence for long term success. I asked to see the data. Nobody's bothered, after three weeks, to send me a thing. One person admitted that there was a high incidence of relapse but claimed that resuming a few sessions quickly put the person back on track. And when I was invited to debate one of the cognitive biggies and accepted, sending along the outline of my argument, they suddenly withdrew the invitation.

I suggest you read Jerome Bruner's "Acts of Meaning." He was one of the originators of cognitive work and his book demonstrates how what was in the beginning an attempt to help people find meaning has been co-opted by behaviorists who promote a mechanistic model of the psyche.

I am interested in your argument that grounds the rejection of cognitive work in the culture of psychotherapy. However, it's equally true that cognitive work itself, by displacing the question of meaning and focusing on symptoms, is itself part of the culture of contemporary psychotherapy. In other words: Being short-term, supposedly, it gratifies insurance companies. And then, when they stop paying, the clients show up at the doors of psychodynamic types looking for something more.

That said, I'm glad the stuff works for you but you do seem to work REALLY hard at it. And that is one of the underlying assumptions of cognitive therapy: high motivation on the part of the client. I think when people are that highly motivated, it probably has a good chance of being helpful, but the same would be true of any other therapy. Where the will is disabled, cognitive work simply doesn't work well.

 

[HULKSTER]

I get Social Anxiety Disorder everytime I have to get up and go to work.

 

[collegiateLifter]

I've learned how to control my anxiety and tone it down through smoking pot; it helped give me perspective

 

[buddy28]

Re: Re: Re: Re: Social anxiety disorder

I am interested in your argument that grounds the rejection of cognitive work in the culture of psychotherapy.

I cant say categorically I support absolute separation of patient practised cognitive therapy from traditional treatment notions originating in contemporary psychotherapeutic culture. Contemporary psychotherapeutic 'culture' is a massive field consisting of a theoretical and practical knowledge set i cant claim to know intimately. That being said, there are parts of contemporary psychotherapeutic philosophy which I reject and accept based on their ability to serve the varied interests of the patient

In my own experience, working with the appropriate cognitive tools in a solitary setting has allowed me to explore and accept otherwise inaccessible truths about myself, simply due to the nature of what I have. Social anxiety, depending on its severity and variation within the individual, is usually accompanied by intense internal criticism and self consciousness associated with the candid expression of emotions generally considered healthy. This nasty little voice turns rational expression and feeling on its head, making the individual feel terribly ashamed and embarrassed for allowing cathartic emotional release around others, and the logical alternative of repression, however dysfunctional, becomes more attractive.

My personal opinion - patient applied cognitive therapy is a legitimate alternative for able individuals who feel extremely reluctant to confront and express emotional trauma around others, at least in the early-middle stages of treatment. The benefits of interpersonal contact for almost all mental disorders, of course, cannot be underscored enough. But I think select cases could certainly benefit from limited interpersonal therapeutic contact in addition to patient applied cognitive/behavioural therapy.

That has been my experience at least.

However, it's equally true that cognitive work itself, by displacing the question of meaning and focusing on symptoms, is itself part of the culture of contemporary psychotherapy. In other words: Being short-term, supposedly, it gratifies insurance companies.

This is interesting. Although cognitive therapy has demonstrated its effectiveness in treating a variety of behavioural and affective disorders, its focus on altering cognitive constructs that largely underlie the manifestations of the particular disorder, usually in a expedited fashion, is a lucky coincidence IMO. Both for mental disorder sufferers and the insurance companies holding the bill.

I definitely can appreciate ur contention cognitive therapy is the darling of insurance companies because it can and does offer a relatively quick and permanent fix for select maladies if applied correctly and *consistently*. This is a godsend not just to the insurance companies but also to the sufferers; many of whom don’t have the luxury to speculate as to possible ethical implications of practising a therapeutic technique having few existential pointers because the disorder is usually so debilitating to begin with, anything that promises permanent releif from unrelenting mental anguish is welcomed with open arms.

ex. If you throw a drowning man a life buoy, he's not going to care what colour it is.

And then, when they stop paying, the clients show up at the doors of psychodynamic types looking for something more.

I don’t doubt it. But I’m going to speculate here many psychodynamic clients looking for deeper life meaning have largely stable emotions, which allow them to pursue more abstract theories of existence and personal consequence largely irrelevant to individuals severely afflicted by a particular malady.

Alternatively, whose to say many psychodynamic clients don’t end up at the offices of cognitive therapists looking for a personal revelation which eluded them during their exploration of psychodynamic philosophy.


Granted, the psychodynamic tradition definitely offers a greater theoretical breadth and depth to understanding the human psyche with possible existential/theological implications. But many people in the world are satisfied with the assumed innate worth afforded to individuals espoused by the cognitive/humanistic camp and leave it there, or look for alternative meaning in the traditional world religions.

That said, I'm glad the stuff works for you but you do seem to work REALLY hard at it. And that is one of the underlying assumptions of cognitive therapy: high motivation on the part of the client. I think when people are that highly motivated, it probably has a good chance of being helpful, but the same would be true of any other therapy. Where the will is disabled, cognitive work simply doesn't work well.

Well, that last parts certainly up for debate But thanks for your support. I was pushing it really hard. Too hard for awhile. But ive settled it down and back on track.

 

[musclebrains]

Re: Re: Re: Re: Re: Social anxiety disorder

I cant say categorically I support absolute separation of patient practised cognitive therapy from traditional treatment notions originating in contemporary psychotherapeutic culture. Contemporary psychotherapeutic 'culture' is a massive field consisting of a theoretical and practical knowledge set i cant claim to know intimately. That being said, there are parts of contemporary psychotherapeutic philosophy which I reject and accept based on their ability to serve the varied interests of the patient

In my own experience, working with the appropriate cognitive tools in a solitary setting has allowed me to explore and accept otherwise inaccessible truths about myself, simply due to the nature of what I have. Social anxiety, depending on its severity and variation within the individual, is usually accompanied by intense internal criticism and self consciousness associated with the candid expression of emotions generally considered healthy. This nasty little voice turns rational expression and feeling on its head, making the individual feel terribly ashamed and embarrassed for allowing cathartic emotional release around others, and the logical alternative of repression, however dysfunctional, becomes more attractive.

I'm unclear how this differs from reading a self-help book and practicing exercises at home alone. I am very mistrustful of any therpeutic modality that doesn't involve more than the individual and his thoughts. Is it worth noting the irony that you're talking about treating SAD without another person present? Is your lens also your symptom? One argument in classic therapy is that, through, transference, the therapist takes on the projections of the client and provides a container for working through the anxieties that underlie the projections. Of course, that takes quite a while.

My personal opinion - patient applied cognitive therapy is a legitimate alternative for able individuals who feel extremely reluctant to confront and express emotional trauma around others, at least in the early-middle stages of treatment. The benefits of interpersonal contact for almost all mental disorders, of course, cannot be underscored enough. But I think select cases could certainly benefit from limited interpersonal therapeutic contact in addition to patient applied cognitive/behavioural therapy.

That has been my experience at least.

Well that's interesting. One of the growing critiques of psychodynamic practice is that the recollection and catharsis of "trauma" actually re-traumatizes the client, and entrenches his disorder. (The NYT Magazine did a lengthy article on this a few weeks back.) The argument, cognitive based, is that clients should learn to "repress" their memories. I find this to be more true than not, having done considerable primal work. I met people who have been laying in safe rooms, shouting at their mommies, for years. However, a psychodynamic approach does not require reiterative catharsis.

This is interesting. Although cognitive therapy has demonstrated its effectiveness in treating a variety of behavioural and affective disorders, its focus on altering cognitive constructs that largely underlie the manifestations of the particular disorder, usually in a expedited fashion, is a lucky coincidence IMO. Both for mental disorder sufferers and the insurance companies holding the bill.

I definitely can appreciate ur contention cognitive therapy is the darling of insurance companies because it can and does offer a relatively quick and permanent fix for select maladies if applied correctly and *consistently*. This is a godsend not just to the insurance companies but also to the sufferers; many of whom don’t have the luxury to speculate as to possible ethical implications of practising a therapeutic technique having few existential pointers because the disorder is usually so debilitating to begin with, anything that promises permanent releif from unrelenting mental anguish is welcomed with open arms.

ex. If you throw a drowning man a life buoy, he's not going to care what colour it is.

Then again, if the life buoy is perforated, he might want something more secure to hold onto: like meaning in his life. And that might be something more than clining to a method.

But I’m going to speculate here many psychodynamic clients looking for deeper life meaning have largely stable emotions, which allow them to pursue more abstract theories of existence and personal consequence largely irrelevant to individuals severely afflicted by a particular malady. Alternatively, whose to say many psychodynamic clients don’t end up at the offices of cognitive therapists looking for a personal revelation which eluded them during their exploration of psychodynamic philosophy.

I've referred plenty of people to cognitive work. My experience is that the techniques start to slip when the underlying gestalt, unaddressed, begins to assert itself. I consider this a demonstration of the fact that the psyche operates as more than a cognitive linquisitic machine.

Your assumption about clients doing psychodynamic work is not accurate. Most are very unstable emotionally. In analytical-based work there is often a presumption that the individual is fundamentally stable and wishes, by exploring his memories, fantasies, dreams, experiences, to discern meaning and purpose in existence. This is very far from an abstract experience. In fact, it almost always stresses the involvement of the body and, in my view, bears more in common with aesthetics than science.

[BGranted, the psychodynamic tradition definitely offers a greater theoretical breadth and depth to understanding the human psyche with possible existential/theological implications. But many people in the world are satisfied with the assumed innate worth afforded to individuals espoused by the cognitive/humanistic camp and leave it there, or look for alternative meaning in the traditional world religions. [/B]

Yes, I agree, it's up to the client. As you know, I oppose most conventional therapies. However, the discovery of innate worth is far different from discerning one's personal meaning and purpose.