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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Budgie on August 15, 2003, at 21:04:16
Hi there,
Some illuminating things have been coming out in my sessions lately- like just how incredibly deep my fear of rejection runs and how far back it goes. I had also forgotten how much I dreaded my first weeks of preschool and kindergarten, and moving to new schools. In a little over a week, I'll be starting my senior year in college, and I'm still dealing with anxiety over it.
How have other people dealt with these issues? I'm sure fear of rejection must be almost a universal thing with people suffering problems like ours. School shyness just seems like early stage social anxiety, which I've suffered from full-blown for 7 years now. What techniques or changes in perspective have people found helpful, besides and in addition to meds, for SA?
Thanks
Posted by Dinah on August 16, 2003, at 14:03:03
In reply to School shy, fear rejection, posted by Budgie on August 15, 2003, at 21:04:16
Hi Budgie,
I think that for most anxiety disorders, including social anxiety, Cognitive Behavior Therapy has a lot to offer. I largely got my obsessive compulsive disorder under control with CBT techniques.
Probably for social anxiety, there'd be some challenging of distorted beliefs. (for example, what do you think others think of you? or are you catastrophizing the possible outcomes of social interactions? etc.) Then there would be some anxiety tolerance techniques, like breathing, etc. to get you through the social situations. All leading to helping you engage socially even when you're afraid. As you have positive experiences, your anxiety should diminish.
Of course, I'm hung over from Seroquel this morning so I may have gotten it all messed up. Perhaps some other posters might have more helpful suggestions.
Does your therapist do any CBT work?
Posted by fallsfall on August 16, 2003, at 15:40:20
In reply to Re: Calling all CBT specialists - Matt? » Budgie, posted by Dinah on August 16, 2003, at 14:03:03
I think that part of the CBT approach would be getting you gradually used to what you are afraid of. So if you have social anxiety, say eating in the cafeteria you might:
Look through the cafeteria windows
Walk through the door and stand in the entryway
Sit at a table when there aren't other kid's eating
Sit at a table in the back when it is crowded
Eat at a table in the back when it is crowded
Eat at a table in the middle
Get your own foodEtc. So the first ones aren't so hard and you keep working up to harder things.
For fear of rejection, I would think that you would first identify what situations make you fearful. You can ask yourself if you would reject someone under those circumstances - would your best friend? Then when you encounter the situation, if you can find some way to verify whether the person is rejecting you or not (Ask them to do you a small favor, or to do something with you). I found that I was MUCH harder on myself than anybody else. Once you know that the fear goes away.
Good luck with school!!
Posted by JonW on August 18, 2003, at 9:20:13
In reply to School shy, fear rejection, posted by Budgie on August 15, 2003, at 21:04:16
> How have other people dealt with these issues? I'm sure fear of rejection must be almost a universal thing with people suffering problems like ours. School shyness just seems like early stage social anxiety, which I've suffered from full-blown for 7 years now. What techniques or changes in perspective have people found helpful, besides and in addition to meds, for SA?
CBT for social anxiety disorder can change your life. It is crucial that you have a CBT therapist who specializes in social anxiety disorder. The best place in the country to do CBT for SAD is the AACT at Temple University. If you are anywhere near Philadelphia, do it there! The people at the AACT are the leading researchers for CBT for SAD. They have all sorts of programs designed for all different kinds of people in different situations. It's a process that starts by just meeting with the therapist each week, but then they bring other people into the sessions and set up "exposures" for you to face in a safe environment. You use the "exposures" to practice and learn from and then face slightly less difficult situations in real life between sessions. The insights of the therapists there can be invaluable. They are so exact, and their knowledge is the product of some very focused research. It's a gradual and very effective process. I've done CBT with other therapists, but going to the AACT convinced me that CBT actually works. If you don't live anywhere near Philly, you may still want to contact them for a referral. Here's their website:
http://www.temple.edu/phobia/old/index.htm
Good luck,
Jon
Posted by Budgie on August 19, 2003, at 0:42:59
In reply to Re: School shy, fear rejection » Budgie, posted by JonW on August 18, 2003, at 9:20:13
Hi, thank you all for your response and concern.
Have any of you combined CBT with medication? I've found meds that have helped me so much that it seems almost silly to also do these CBT exercises (not that I've tried), because the fear and paranoia is magically gone. And it's strange- the SA has come and gone in waves (always concurrent with depression) over the years so much that I've had many, many exposures already to the situations that I fear the most. Sometimes I even do splendidly. I guess my point is that I'm not exactly starting from square one. I know exactly what it's like to be be social and friendly, just like I know exactly what it's like to not feel depressed.
For me, stress, depression, and SA are just so intertwined, it's hard to seperate them. But that's exactly what I want to do with them so I can understand and deal with them. They all just seem to happen when things start to go wrong. And it's so frustrating, because I'll find myself in a social situation, with people with whom I've got along wonderfully in the past, but these reactions and impulses just happen, and next thing I know, I'm a nervous wreak. I know I'm not scared, but yet I am!
It seems more of a biological response to stress than anything, but of course I know there's something driving that response down deep in my subcoscious, or so I imagine.
I was thinking more along the lines of true psychotherapy. Has anyone had positive experiences with that?
Thanks for listening.
Posted by Dinah on August 19, 2003, at 0:51:23
In reply to Re: School shy, fear rejection, posted by Budgie on August 19, 2003, at 0:42:59
If medications on their own work for you, and you don't think you *always* have a problem, just when you're depressed, why not just use a medication approach?
Unless you think there is a psychological reason for your depressive episodes. Or since you mentioned stress as part of the equation, do you feel like you need to learn stress reduction techniques in order to avoid the depression and social anxiety?
Posted by mattdds on August 19, 2003, at 10:24:31
In reply to Re: School shy, fear rejection » Budgie, posted by Dinah on August 19, 2003, at 0:51:23
Hello,
Yeah, I agree, if meds seem to do the trick, and your social anxiety is only when depressed, perhaps a medication only approach is worthwhile.
CBT certainly is more time consuming, frustrating and challenging! It's hard to do it with a lot going on in your life. And yes, some of the exercises do seem silly. That is one of the first obstacles you would have to overcome if you want to try CBT.
CBT worked magically for me across the entire spectrum of anxiety disorders (I have PD, SA and GAD with comorbid depression).
But if meds work magically, as you say, why fix what ain't broken?
Best of luck to you. Social anxiety is a real bummer!
Best,
Matt
Posted by JonW on August 19, 2003, at 10:28:17
In reply to Re: School shy, fear rejection, posted by Budgie on August 19, 2003, at 0:42:59
> Have any of you combined CBT with medication?
Yes. I find CBT + meds to be highly synergistic. I take moclobemide, but in general, it's not a very potent drug for SAD. It's very helpful for me in combination, though.
>I've found meds that have helped me so much that it seems almost silly to also do these CBT exercises (not that I've tried), because the fear and paranoia is magically gone.
Some people with SAD get remission with medication alone. If you are one of these people, why not just take the meds?
>And it's strange- the SA has come and gone in waves (always concurrent with depression) over the years so much that I've had many, many exposures already to the situations that I fear the most.
Exposure alone is not CBT. In fact, exposure alone can make SAD and other anxiety disorders worse. This is not the case with phobias, but social anxiety disorder is not a phobia.
>Sometimes I even do splendidly. I guess my point is that I'm not exactly starting from square one. I know exactly what it's like to be be social and friendly, just like I know exactly what it's like to not feel depressed.
Having social skills and having experienced social success is one thing. The question is how big of a problem social anxiety is in your life. Social anxiety, in of itself, is a normal part of life. Does it prevent you from achieving what you want?
> For me, stress, depression, and SA are just so intertwined, it's hard to seperate them. But that's exactly what I want to do with them so I can understand and deal with them. They all just seem to happen when things start to go wrong. And it's so frustrating, because I'll find myself in a social situation, with people with whom I've got along wonderfully in the past, but these reactions and impulses just happen, and next thing I know, I'm a nervous wreak. I know I'm not scared, but yet I am!
You may not be open to CBT right now, and that's fine, but CBT is all about separating interconnected experiences. And it gives you the tools to learn from that knowledge.
> It seems more of a biological response to stress than anything, but of course I know there's something driving that response down deep in my subcoscious, or so I imagine.
Social anxiety definitely has a biological component, but that doesn't mean medication alone is the only solution or even the best solution. I don't understand, though. If medication alone works for you, what's the problem?
> I was thinking more along the lines of true psychotherapy. Has anyone had positive experiences with that?
Anyone can respond to any treatment, but the only psychological therapy that's demonstrated efficacy for SAD is CBT. Therapy with a CBT therapist is not a cold, clinical experience. It offers understanding, insight, friendship, and is at least as effective as Nardil for SAD. Obviously, combining medication with therapy is the best of both worlds.
CBT may not be for you, but as people with social anxiety disorder are experts at avoiding things, you may want to ask yourself if any reluctance to pursue this avenue isn't just another form of avoidance. If you are not getting what you want from medication alone, don't rule this out.
Jon
Posted by mattdds on August 19, 2003, at 12:42:34
In reply to Re: School shy, fear rejection » Budgie, posted by JonW on August 19, 2003, at 10:28:17
Posted by Budgie on August 19, 2003, at 22:20:11
In reply to Very well said JonW (nm) » JonW, posted by mattdds on August 19, 2003, at 12:42:34
Yes, thank you all for responding, I know there's a great deal of truth in what you're saying.
If there is one thing I know how to do, it's avoid things. :)
Medication alone (with regular individual therapy) seems to be doing well right now. I only bring up the question because one always hears doctors and studies say how much more effective combination approaches are. Maybe it's a bit of guilt. :)
Thanks,
Budgie
Posted by JonW on August 20, 2003, at 14:19:51
In reply to Very well said JonW (nm) » JonW, posted by mattdds on August 19, 2003, at 12:42:34
This is the end of the thread.
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