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| Anxiety Disorders Fear is a normal reaction to an external source of danger. It is appropriate to the source of danger in its intensity and duration, and dissipates when action is taken to escape or avoid the source of danger. Anxiety
is a reaction to a real or imagined threat, a general feeling of uneasiness or
dread. An anxiety disorder does just the opposite, it
keeps you from coping and disrupts your daily life. This kind of anxiety
is the debilitating kind, it paralyses and immobilizes the person. Anxiety
involves tension, apprehension and terror about real or imagined danger... the
source of which is unknown. There are several types of anxiety
disorders, each with its own distinct features. Situational Anxiety occurs in response to a specific stress and ends after the stress is removed. Free-floating Anxiety involves apprehension that is not linked to any specific situation or event. The degree of anxiety is much more a function of the individual's coping skills than the degree of stress. The risk of anxiety increases with stress, a family history of neurosis, fatigue or overwork, or the recurrence of situations that have been previously stressful or harmful. Signs and Symptoms:
[Types
of Anxiety Disorders] [Anxiety
in Adolescents and Children] Factoids Mental Illnesses impose a multibillion dollar
burden on the economy each year. Total economic costs amounted to $147.8 billion
in 1990. More than 31 percent of those costs are for anxiety disorder. References and Links: What is Social Anxiety? Social anxiety is the fear of social situations and the interaction with other people that can automatically bring on feelings of self-consciousness, judgment, evaluation, and inferiority. Put another way, social anxiety is the fear and anxiety of being judged and evaluated negatively by other people, leading to feelings of inadequacy, embarrassment, humiliation, and depression. If a person usually becomes anxious in social situations, but seems fine when they are alone, then "social anxiety" may be the problem. Social anxiety disorder (formerly termed "social phobia") is a much more common problem than past estimates have led us to believe. Millions of people all over the world suffer from this devastating and traumatic problem every day, either from a specific social anxiety or from a more generalized social anxiety. In the United States, epidemiological studies have recently pegged social anxiety disorder as the third largest psychological disorder in the country, after depression and alcoholism. It is estimated that 7-8% of the population suffers from some form of social anxiety at the present time. The lifetime prevalence rate for developing social anxiety disorder is 13-14%. Specific and Generalized Social Anxieties A specific social anxiety would be the fear of speaking in front of groups (only), whereas people with generalized social anxiety are anxious, nervous, and uncomfortable in almost all social situations. It is much more common for people with social anxiety to have a generalized type of this disorder. When anticipatory anxiety, worry, indecision, depression, embarrassment, feelings of inferiority, and self-blame are involved across most life situations, a generalized form of social anxiety is at work. Symptoms of Social Anxiety Disorder People with social anxiety disorder usually experience significant emotional distress in the following situations: Being introduced to other people Being teased or criticized Being the center of attention Being watched while doing something Meeting people in authority ("important people") Most social encounters, especially with strangers Going around the room (or table) in a circle and having to say something Interpersonal relationships, whether friendships or romantic This list is certainly not a complete list of symptoms -- other feelings have been associated with social anxiety as well. The physiological manifestations that accompany social anxiety may include intense fear, racing heart, turning red or blushing, excessive sweating, dry throat and mouth, trembling, swallowing with difficulty, and muscle twitches, particularly about the face and neck. Constant, intense anxiety that does not go away is the most common feature. People with social anxiety disorder know that their anxiety is irrational and does not make "head" (i.e., cognitive) sense. Nevertheless, "knowing" something is not the same thing as "believing" and "feeling" something. Thus, for people with social anxiety, thoughts and feelings of anxiety persist and show no signs of going away -- despite the fact that socially-anxious people "face their fears" every day of their lives. Only the appropriate therapy works to alleviate social anxiety disorder, the largest anxiety disorder, and the one that few people know anything about. Therapy for Social Anxiety Disorder The good news is that cognitive-behavioral therapy for social anxiety has been markedly successful. Research and clinical evidence alike indicate that cognitive-behavioral therapy, which should be comprehensive in nature, produces permanent changes in the lives of people. Social anxiety disorder can be overcome, although it takes both consistency and persistence. But, barring cognitive problems (e.g., dementia, Alzheimer's Disease) everyone can make progress against social anxiety using the appropriate type of cognitive-behavioral therapy. At The Social Anxiety Institute, we call cognitive-behavioral therapy for social anxiety disorder "comprehensive" cognitive-behavioral therapy, to differentiate it from the general idea that cognitive concepts are simplistic and can be addressed by using only a few strategies. A successful therapy program for social anxiety disorder must address the dozens of cognitive methods, strategies, and concepts that will allow people's brains (i.e., their brain associations or neural pathways) to literally change. The brain is continually learning, and irrational thoughts and beliefs can change as a result of this cognitive process. A good therapy program will supply the necessary and specific strategies as well as indicate to people how and why they need to practice, work on, and begin to accept rational thoughts, beliefs, emotions, and perceptions. How To Find Help for Social Anxiety Disorder Social anxiety, as well as the other anxiety disorders, can be successfully treated. In seeking help for this problem, search for a specialist -- someone who (a) understands this problem well and (b) knows from experience how to treat it. Become an informed client and ask questions. For example, does the therapist understand that you feel very self-conscious and that others are watching and forming a negative evaluation about you? – or do they minimize what you’re saying and just say, "No, No, No, you’re fine ... you're just exaggerating...." or expect you to go out and do unreasonable "exposures"? It is true that we who have lived through social anxiety do realize our mind is many times irrational and we over-exaggerate, but it still FEELS like others are watching and judging us. Our self-consciousness is a feeling and it is very real. If your psychologist/mental health care worker does not understand this, you know more than they do about social anxiety. Under these circumstances, it is very doubtful they will be able to help you. Also, remember that the professional should always welcome your questions. If someone seems unfriendly or too clinical, they should not be your choice of a therapist. Those of us who have (or have had) social anxiety need support, encouragement, and a relatively stress-free environment while we are in therapy that will permanently change our thoughts, beliefs, feelings, and our lives. Does your therapist say, "Face your fears and they’ll go away?" Sorry, but this therapist does not understand the dynamics of social anxiety. We, as people with social anxiety, have constantly faced our fears ever since birth – we’ve had to – and we feel more fearful now than we did in the past. In this case, seek another therapist. It is imperative you find a psychologist who understands social anxiety disorder completely – because if they don’t even know what it is – how will they know what to do to help you overcome it? Getting over social anxiety disorder is not an easy task, nor is it a difficult one. Many thousands of people have already done it. While you’re in the middle of the social anxiety syndrome, it feels hopeless – it feels that you’ll never get any better. Life is just one gut-wrenching anxiety problem after another. But this can be stopped, quenched, and killed in a relatively short period of time – by finding a cognitive-behavioral therapist who understands and specializes in the treatment of social anxiety. The most important elements in overcoming social anxiety: 1. An understanding and awareness of the problem, 2. A commitment to carry through with cognitive-behavioral therapy even when it is repetitious and seems difficult, 3. Practice, practice, practice to get that information (i.e., cognitive methods, strategies, and concepts) deep down into your brain - so that these cognitive methods become habitual and automatic, 4. Participation in a social anxiety therapy group in which you can slowly and gradually work on problems that cause you anxiety in the real world. That is, the person who feels anxious while reading in public uses specific strategies to meet his goal, whereas the person who wants to learn how to make introductions and engage in small talk during social activities slowly works toward her goals. We use role-plays, acting, the tape recorder and video camera, question and answer periods, mock job interviews, and doing foolish things deliberately as part of our behavioral therapy group for people with social anxiety. Note: A ladder or "hierarchy" should be used as a flexible guide in planning. We want to practice, meet our goals, move up our expectations, meet our goals, move up our expectations, until our goal is finally met. Social anxiety behavioral therapy groups should not pressure, push, or cajole people to do things. No negative tactic should be employed because the individual must choose to participate at her own pace. If she wants to sit there in group and not say a word, that’s O.K. No one should be made to do anything. How do people get better, then, you may be asking. Here’s the secret: This has never happened. People in the group understand why they are there and, despite an amount of anxiety that is naturally present, they voluntarily choose to work on their specific anxieties. This is much more practical and real-life than being forced to do something. Therapy groups for social anxiety should always be encouraging, positive, and supportive. If the right atmosphere is set, people can make (and continue to make) progress up their "hierarchy" of social anxieties. It is impossible to stop a motivated person who refuses to give up. The role of the therapist is to know specifically what to do and how quickly to do it. This sounds easy, but it is not. You must be practicing the right material and you must proceed at the correct pace for your own anxieties. You are more in control of this process than you think. Today, cognitive-behavioral therapy is used to treat both forms of social anxiety. With cognitive-behavioral therapy, we do not wallow in the past and continually bring it up --- because it doesn’t do us any good. Instead, we focus on present-day problems and symptoms and use many small techniques and methods to eradicate anxiety thinking, feelings, beliefs, and belief systems. Here’s where motivation and practice come in. The more you can practice these small techniques at home, the quicker anxiety can be reduced and social anxiety can be overcome. Social phobia source: http://www.anxietynetwork.com/sphome.html Social phobia is the third largest psychological problem in the world today.....no one knows this..... A woman hates to stand in line in the grocery store because she’s afraid that everyone is watching her. She knows that it’s not really true, but she can’t shake the feeling. While she is shopping, she is conscious of the fact that people might be staring at her from the big mirrors on the inside front of the ceiling. Now, she has to talk to the person who’s checking out the groceries. She tries to smile, but her voice comes out weakly. She’s sure she’s making a fool of herself. Her self-consciousness and her anxiety rise to the roof. A man finds it difficult to walk down the street because he’s self-conscious and feels that people are watching him from their windows. Worse, he may run into a person on the sidewalk and be forced to say hello to them. He’s not sure he can do that. His voice will catch, his "hello" will sound weak, and the other person will know he’s frightened. More than anything else, he doesn’t want anyone to know that he’s afraid. He keeps his eyes safely away from anyone else’s gaze and prays he can make it home without having to talk to anyone. "There are seven miserable days of anxiety and worry ahead of her to think about it....over and over and over again....." Another person sits in front of the telephone and agonizes because she’s afraid to pick up the receiver and make a call. She’s even afraid to call an unknown person in a business office about the electric bill because she’s afraid she’ll be "putting someone out" and they will be upset with her. It’s very hard for her to take rejection, even over the phone, even from someone she doesn’t know. She’s especially afraid to call people she knows because she feels that she’ll be calling at the wrong time -- the other person will be busy — and they won’t want to talk with her. She feels rejected even before she makes the call. Once the call is made and over, she sits, analyzes, and ruminates about what was said, what tone it was said in, and how she was perceived by the other person....her anxiety and racing thoughts concerning the call prove to her that she "goofed" this conversation up, too, just like she always does. Sometimes she gets embarrassed just thinking about the call. A man hates to go to work because a meeting is scheduled the next day. He knows that these meetings always involve co-workers talking with each other about their current projects. Just the thought of speaking in front of co-workers raises his anxiety. Sometimes he can’t sleep the night before because of the anticipatory anxiety that builds up. Finally, the meeting is over. A big wave of relief spills over him as he begins to relax. But the memory of the meeting is still uppermost in his mind. He is convinced he made a fool of himself and that everyone in the room saw how afraid he was when he spoke and how stupid he acted in their presence. At next week’s meeting, the boss is going to be there. Even though this meeting is seven days away, his stomach turns raw with anxiety and the the fear floods over him again. He knows that in front of the boss he’ll stammer, hesitate, his face will turn red, he won’t remember what to say, and everyone will witness his embarrassment and humiliation. He has seven miserable days of anxiety ahead of him, to think about it, ruminate over it, worry about it, overexaggerate it in his mind...again and again and again... A student won’t attend her university classes on the first day because she knows that in some classes the professor will instruct them to go around the room and introduce themselves. Just thinking about sitting there, waiting to introduce herself to a roomful of strangers who will be staring at her makes her feel nauseous. She knows she won’t be able to think clearly because her anxiety will be so high, and she is sure she will leave out important details. Her voice might even quaver and she would sound scared and tentative. The anxiety is just too much to bear -- so she skips the first day of class to avoid the possibility of having to introduce herself in public. Another young man wants to go to parties and other social events -- indeed, he is very, very lonely -- but he never goes anywhere because he’s very nervous about meeting new people. Too many people will be there and crowds only make things worse for him. The thought of meeting new people scares him -- will he know what to say? Will they stare at him and make him feel even more insignificant? Will they reject him outright? Even if they seem nice, they’re sure to notice his frozen look and his inability to fully smile. They’ll sense his discomfort and tenseness and they won’t like him – there’s just no way to win – "I’m always going to be an outcast," he says. And he spends the night alone, at home, watching television again. He feels comfortable at home. In fact, home is the only place he does feel comfortable. He hasn’t gone anywhere in twelve years. In public places, such as work, meetings, or shopping, people with social phobia feel that everyone is watching and staring at them (even though rationally they know this isn’t true). The socially anxious person can’t relax, "take it easy", and enjoy themselves in public. In fact, they can never relax when other people are around. It always feels like others are evaluating them, being critical of them, or "judging" them in some way. The person with social phobia knows that people don’t do this openly, of course, but they still feel the self-consciousness and the judgment while they are in the other person’s presence. It’s sometimes impossible to let go, relax, and focus on anything else except the anxiety. Because the anxiety is so very painful, it’s much easier just to stay away from social situations and avoid other people. "More than anything, he doesn’t want anyone to know he’s afraid...." Many times people with social anxiety simply must be alone -- closeted -- with the door closed behind them. Even when they’re around familiar people, a person with social phobia may feel overwhelmed and have the feeling that others are noticing their every movement and critiquing their every thought. They feel like they are being observed critically and that other people are making negative judgments about them. One of the worst circumstances, though, is meeting people who are "authority figures". Especially people such as bosses and supervisors at work, but including almost anyone who is seen as being "better" in some way. People with social anxiety may get a lump in their throat and their facial muscles may freeze up when they meet this person. The anxiety level is very high and they’re so focused on "not failing" and "giving themselves away" that they don’t even remember what was said. But later on, they’re sure they must have said the wrong thing.....because they always do. How is it ever possible to feel "comfortable" or "natural" under these circumstances? To the person with social anxiety, going to a job interview is pure torture: you know your excessive anxiety will give you away. You’ll look funny, you’ll be hesitant, maybe you’ll even blush, and you won’t be able to find the right words to answer all the questions. Maybe this is the worst part of all: You know that you are going to say the wrong thing. You just know it. It is especially frustrating because you know you could do the job well if you could just get past this terrifying and intimidating interview. Welcome to the world of the socially anxious. Social anxiety is the third largest psychological problem in the United States today. This type of anxiety affects 15 million Americans in any given year. Unlike some other psychological problems, social phobia is not well understood by the general public or by medical and mental health care professionals, such as doctors, psychiatrists, psychologists, therapists, social workers, and counselors. In fact, people with social phobia are misdiagnosed almost 90% of the time. People coming to our anxiety clinic with diagnosable DSM-IV social phobia have been mislabeled "schizophrenic", "manic-depressive", "clinically depressed", "panic disordered", and "personality disordered", among other misdiagnoses. Because few socially-anxious people have heard of their own problem, and have never seen it discussed on any of the television talk shows, they think they are the only ones in the whole world who have these terrible symptoms. Therefore, they must keep quiet about them. It would be awful if everyone realized how much anxiety they experienced in daily life. Unfortunately, without some kind of education, knowledge and treatment, social anxiety continues to wreak havoc throughout their lives. Adding to the dilemma, when a person with social phobia finally gets up the nerve to seek help, the chances that they can find it are very, very slim. Making the situation more difficult is that social anxiety does not come and go like some other physical and psychological problems. If you have social phobia one day...you have it every day for the rest of your life, unless you receive the appropriate therapy. The feelings I described to you at the beginning of the article are those of people with "generalized" social phobia. That is, these symptoms apply to most social events and functions in almost every area of life. I suffered from social phobia myself for twenty years before I ever saw the term or read about its symptoms in a book. As with all problems, everyone with social anxiety has slightly different symptoms. Some people, for example, cannot write in public because they fear people are watching and their hand will shake. Others are very introverted and they find it too difficult to hold down a job. Still others have severe anxiety about eating or drinking in the presence of other people. Blushing, sweating, and "freezing" are other physiological symptoms. Some people with social anxiety feel that a certain part of their body (such as the face or neck) are particularly "strange looking" and vulnerable to being stared at. One thing that all socially anxious people share is the knowledge that their thoughts and fears are basically irrational. That is, people with social anxiety know that others are really not critically judging or evaluating them all the time. They understand that people are not trying to embarrass or humiliate them. They realize that their thoughts and feelings are somewhat irrational. Yet, despite this rational knowledge, they still continue to feel that way. It is these automatic "feelings" and thoughts that occur in social situations that must be met and conquered in therapy. Usually these feelings are tied to thoughts that are entwined in a vicious cycle in the persons’ mind. How can social anxiety be treated? Many therapeutic methods have been studied, but cognitive-behavioral techniques have been shown to work the best. In fact, treatment of social anxiety through these cognitive-behavioral methods produces long-lasting, permanent relief from the anxiety-laden world of social anxiety. A better life exists for all people who suffer from social anxiety..... Social anxiety responds to relatively short-term therapy, depending on the severity of the condition. To overcome social anxiety, completion of one or more CBT therapy groups is essential. What socially-anxious people do not need is years and years of therapy. In fact, socially anxious people who are taught to "analyze" and "ruminate" over their problems usually make their social anxiety worse. There is a better life for all people with social anxiety. Without treatment, social phobia is a torturous emotional problem; with treatment, its bark is worse than its bite. Add to this that the current research is clear that cognitive-behavioral therapy is highly successful in the treatment of social anxiety. In fact, people who are unsuccessful are the ones who are not persistent in their therapy and who won’t practice simple routines at home they are the ones who give up. If a person is motivated to end the years of crippling anxiety, then cognitive-behavioral treatment provides methods, techniques, and strategies that all combine to lessen anxiety and make the world a much more enjoyable place. Many of us have been through the crippling fears and constant anxiety that social phobia produces -- and have come out healthier and happier on the other side. Sources: American Psychiatric Association. Public Information: Let's Talk Facts Pamphlet Series
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