At age 56, I have been exercising for most of my life; primarily a healthy obsession with aerobic activity. I recently hired a trainer. I told him that my objective was to be able to play basketball a couple of times a week without back and knee pain. Three months later, after a regimen of cross training including Pilates and weight training, it appears that I have met my objective. Believe me; my workouts, where I invested in using different muscles with the trainer were hard and they paid off!
Using the metaphor that the brain is a muscle, consider a similar dynamic to help your dependent (or yourself) with selective mutism. The diagnosis for SM is very simple. If you know that your child-dependent does speak, but does not to specific people, or in specific venues, SM is present. SM is social phobia. It can be considered an “addiction to the avoidance of speaking” or a speaking phobia. The mutism is the tip of the iceberg. (It was not the tip of the iceberg that sank The Titanic; it was the ice underneath the water). The underlying dynamics of SM include a complex integration of attitude, cognition, behavior, emotion, and physiology. It is important to identify other diagnostic issues including possible “processing” and/or medical challenges.
As parents you have a tremendous opportunity to help your child the earlier that you are aware of the problem. If you are an adult with SA or SM reading this you probably have the initiative needed to employ “cross training”. The average age of my patients since 1978 has been 27. This fact has been the direct result of a common belief that the “shy” or socially anxious child will simply grow out of the problem. You can read plenty of stories of adults with SA in my book “Beyond Shyness”. Avoidance and dependence can be the basis for specific personality disorders.
Back to my training for a moment; I received as a gift of a really neat athletic watch which I often use during my workouts. Recently when the time changed to “day light savings”, for the life of me, I did not want to spend 15 minutes going though the manual to figure out how to make the change. I could have, but I did not want to experience the discomfort of concentrating. When my step-son visited he did it in 10 seconds. This help was not “enabling” as I do have my life in order.
It is imperative for effective cross training that you understand the concept of “enabling”. It means any behavior by care-givers that inhibits the growth or potential of the child-dependent (of any age).
“Cross training” means learning how not to enable the problem. It means doing things differently; using different muscles to build potential and develop skills. A well known SM expert told the family of a 6 year old, “tell her she does not have to talk”. This “paradoxical” strategy was effective in reducing the stress temporarily. The problem was at age 8 the child was still investing in the concept of “you don’t have to talk” and the parents had no idea of what to do.. The “expert” left out the non-enabling part of the therapeutic strategy. Long term productivity was not achieved. The family came to me two years after seeing the “expert”.
“Enabling” promotes primitive brain functioning even though many SM children (and adults) are very intelligent. It creates an illusion-delusion for the dependent; meaning that child is learning the world will adjust to them instead of they have to learn how to adjust to the world. Non-enabling which is “cross training” will empower the potential of your dependent. “Cross training” must be done methodically! It creates stress for both caregivers and child. It is imperative to learn how to channel this stress into positive energy.
For readers who believe that your child only has the problem in school because he or she is “normal” at home, consider that SM is a form of “performance anxiety” manifested primarily in pressure or challenge venues such as school. “Cross training” is needed by school personnel also. This can only be implemented productively after parents learn their strategy. If not, fragmentation and distress will result. If teachers are not taught therapeutic strategies at the beginning of school it is very easy to lose the year to “enabling” in the academic environment.
Recently I had a headache while driving on The Long Island Expressway from my home to my office. The headache was the result of “attaching” or connecting to stressful thoughts. So I said to myself, “I’m going to think about positive things”. The headache went away about 15 minutes later. The moral of the story was that the cause of the headache, and resolution to the headache, were both the result of “attachment” or connecting.
The last thing that an anxiety sufferer wants is to feel anxiety. After all; why be uncomfortable? Why think about anxiety provoking situations or people ? Why experience uncomfortable emotions or thoughts? Therefore, over time a defense mechanism of “detachment” or disconnecting occurs. Often a social phobia is the result. This is avoidance of the anxiety provoking situation.
For example, a person with public speaking anxiety wants to avoid adrenaline at all costs. The result is hoping that it’s not there; a process which sets up unrealistic expectations and worsens the problem. Dependence on pharmaceuticals or other substances, or avoidance of the situation completely are other common scenarios. The fear of being noticeably nervous; as in blushing and sweating can be so debilitating that many actual consider invasive surgery to cut their nerves!
Another example; many parents of children with selective mutism believe that they never should teach their children about anxiety. To them it’s a dirty word. Forget about emotions and cognition (thinking) and “enabling”; it’s just a speaking problem and one day we will find the right “technique” to resolve the problem all at once” is common thinking. Sadly, nothing is further from the truth as selective mutism is a variation of obsessive compulsive disorder, which is characterized by dramatic “detachment”, or disconnecting on the part of the child. When you observe the child smiling while mute; that’s detachment, not happiness! Listen to interviews of families and individuals who learned to “attach” and resolve this insidious problem.
If you do not learn to attach to your thoughts, emotion, and adrenaline; they will control you!These are dramatic statements obviously! It characterizes paradoxical strategies; a dynamic and system, which has been instrumental in my clinical experience and success during the last 30 years.
Examples include public speaking anxiety sufferers learning to make friends with adrenaline and blushers learning to accept the symptom, which result in its’ diminishing, Listen to the free blushing and performance seminar at www.socialanxiety.com. In the case of selective mutism in children the paradoxical strategy includes teaching parents to restructure their expectations and to turn “enabling” into “empowering”.
Healing does take some work. It’s about the process of attaching to thinking, emotions, behavior, adrenaline and more. While technique is important, those who only want technique without real attachment will experience an inhibited learning curve.
The content in this article will take you past the absurd hype and mis-information that is abundant regarding social anxiety into the beginning of a realistic and productive understanding of the problem! I promise; if the subject of social anxiety is important to you, you will not be bored!
At the end of this article is The Andrew Kukes Story. Read carefully and you can access one of the most important programs for healing for free to the general public, and for continuing education credits for mental health professionals.
To begin; it’s important that you know about my background. After all, if you are going to take advice it’s important to know the quality of the source.
Here’s the short story. In 1976, fresh out of graduate school I was working in a community center as a youth worker. An associate suggested that we start a socialization group for teenagers with learning disabilities. I had no idea what she was talking about, but after doing research I discovered there was no such program. I set up a protocol where the first step was to interview applicants with a parent. Then an interesting phenomenon happened. Many of those interviewed never showed up for the group. This was my discovery of social anxiety in 1976, way before the term became commonly used.
Since this time, I have worked directly with, or supervised treatment for, approximately 10,000 individuals of all ages with social anxiety and related challenges. I have seen everything from a total “cure” (and I don’t use this term lightly) to the problem being permanent, and everything in between. It’s very unlikely that you could tell me anything I have not heard!
The degree of resolution to social anxiety depends on one’s learning curve. Treatment requires an active learning process. It is important to “quarterback” or “pilot” the learning process. Productivity cannot be achieved from a passive or defensive position. This reality upsets and confuses many sufferers, who have unrealistic expectations regarding the healing process.
An example of a common unrealistic expectation is the social anxiety sufferer who has a long term history (let’s say 20 years plus) with substantial anticipatory anxiety, intense obsessive worry, the potential for panic in the challenge scenario, and an avoidant personality and lifestyle who wants to get better in a handful of sessions. I say to this type of individual “maybe if you are a superstar like Michael Jordan (metaphorically speaking). When patients ask me “how long will therapy take?” my response is to clarify therapeutic objectives and teach the variables of the learning curve. Concurrent to this I often respond with the question “how fast can you run?”
It’s often a good idea for the person who is contemplating therapy to start with books and self-help programs to determine if the understand and buy into the concepts and strategies that are presented.
At the beginning of treatment it is very useful to have patients complete a multi-modal life history. It helps organize relevant content, facilitates attachment to the issues, and clarifies expectations.
Given the fact that an active learning process is required, traditional analytical approaches to treatment are often not productive for social anxiety because it is crucial that the therapist be able to actively teach the mechanics and dynamics of healing!
There are a number of variables to the learning process.
The severity of the problem; which requires understanding its’ layers including:
- Severity of anxiety in the challenge scenario.
- Obsessive worry.
- Degree of avoidance.
- Degree of over-dependence.
- Underlying depression or dysthymia.
- The nature of the self-esteem challenge.
The degree of motivation and initiative
Emotional intelligence, as well as, intellectual.
I have worked with many individuals who were extremely intellectually intelligent whose emotional and social intelligence was quite challenged; to say the least.
The ability to process new concepts.
How hard-wired the anxiety is into the personality type in which it is encased.
And last, but certainly not least; the readiness to face fear, which often requires the sufferer to manage the emotions associated with being noticeably nervous.
There is a broad spectrum of how social anxiety manifests. For example, I have worked with countless individuals, who suffer from the specific performance anxiety of public speaking; many who have earned impressive 6 and 7 figure salaries. On the other end of the spectrum are those who have a pervasive social handicap and are not capable of having “initiative” as it apples to improving their mental health. “Initiative” does not mean ability. It means the motivation “to start up”.
An example of this would be the single adult with no social life, who is overly dependent on parents and probably computer games. He or she may or may not work. Many who fit this profile work at a low level jobs; and many work obsessively with very long hours and will do just about anything to avoid socializing. These individuals detest the idea of therapy although the parents, or other “enablers” may think it’s needed. Attempts to engage this type of individual in individual therapy without integrating the enablers into an organized treatment methodology is an absurdity. It happens all the time. Traditional therapy will not work for individuals with this profile, most of the time. There are, of course, exceptions to every rule. A crucial dynamic to understand is the avoidance-dependence syndrome that has so baffled the psychotherapeutic community. Many sufferers who fit this profile function at a “primitive” level. “Primitive” is defined as “spending the least amount of energy possible to sustain baseline functioning”.
An example of this dynamic occurred when I appeared on Oprah in 1988. One patient named “Susan” who presented the theme “she had her first date at age 38” and who had no social life outside of her family, created confusion for Opra. Opra was getting feedback that she was “browbeating” “Susan”. At one point she said “I’m not brow beating her; I just don’t understand; were your parents so much fun that you wanted to be with them all the time?”
A fascinating although complex and daunting symptom of social anxiety is selective mutism. Often mis-diagnosed as a speech disorder, autism, or oppositional disorder, the problem manifests as a talking phobia. An incredible statistic is that approximately 7 in one thousand children are afflicted. There’s very little effective help worldwide. This condition confuses the psychotherapy and medical communities in general, and causes tremendous chaos in school settings. However; it offers a tremendous opportunity to resolve anxiety with appropriate early intervention; before it becomes solidly integrated into the personality. You may want to listen to the free seminar at socialanxiety.com “Selective Mutism and Professional Baseball Player” and the other interviews of families and individuals (including adults) who have resolved selective mutism, which by the way, is a specific example of obsessive compulsive disorder, in addition to being a symptom of social anxiety.
During the last decade a new medical industry has been developed in response to a social anxiety driven problem; hyper-hidrosis. Physicians do an invasive procedure called a sympathectomy, the purpose of which, is to cut nerves in order to control sweating and blushing. This is a great example of the desperation that some social anxiety sufferers experience. You may want to listen to the free seminar at socialanxiety.com “Performance anxiety and Blushing” along with interviews with “blushers” who have healed without such drastic approaches.
A functional understanding of the architecture of social anxiety is imperative if it is going to be controlled. Think of the word FATE.
F = function (physiology)
A = action (behavior)
T = thinking (cognition)
E = emotion
All of these domains must be considered for productive treatment whether it be self-help or real therapy. In addition, it is imperative to factor in the primary personality types that encase social anxiety. These are:
One of the biggest clichés in the psychotherapy profession (and I say this at the risk of offending many) is the reference to Cognitive Behavioral Therapy as it applies to social anxiety. Obviously; cognition and behavior are very important dynamics, but if you do not integrate emotion and physiology into the treatment process, productivity will be limited.
Repressed and recycled emotion drives the obsessive worry and fear that characterizes social and performance anxiety. Much of this content lies in pre-conscious and unconscious domains. Bringing it to a conscious level it imperative for clinical efficacy. This does not necessarily require a lot of time focusing on the past, but is does require an organized analytical methodology.
Another tremendous cliché, often used in therapy and scientific circles, is the reference to “evidence based research”. While research is certainly important, it’s important to understand that much research lags behind the developments of therapists who are on the clinical front line. In addition, there are many ways to manipulate research findings. In addition, often the results of research are determined by funding sources.
Effective treatment for social anxiety must integrate core work with technique. While technique is important, the core work of identifying repressed recycled anger, much of which may not be conscious, along with resolving the emotions of embarrassment, shame, humiliation are imperative.
An example of important technique is the adrenaline control methodology. This technique is based on the paradoxical phenomenon of adrenaline acceptance.
But be very clear; technique alone does not resolve social anxiety!
The resolution of social anxiety requires the management of emotions associated with unwanted physiological responses! Gaining control of this process can be considered psycho-physiological therapy.
Social anxiety is the classic disease of resistance. The typical social anxiety sufferer has learned to “detach”. This means disconnect. The dis-connect is from feelings, thoughts, and physical sensations. After-all, “why feel uncomfortable” thinks the social anxiety sufferer. The problem is that “detachment” is the doorway to avoidance which can evolve into a lifestyle and a personality disorder. To truly resolve social anxiety the sufferer must learn a nurturing interpretation of attachment or connecting to thoughts, feelings, and physiology. Think of it this way. You need to feel that which is to be controlled. Otherwise true control is unlikely.
This introduction would be incomplete without a few words on medication. When I started my private practice in 1978 as a biofeedback practitioner the goal was to avoid the use of medication, or to help the patient get off of medication. However; when social and performance anxiety is characterized by extreme levels of obsessive worry, panic, or depression, it is often productive to integrate medicine with therapy. The philosophy behind this is that the purpose of the medication is to create an internal sense of ease to facilitate doing the core work; the longer term objective is to not need the medication.
It is important to understand the hierarchy of symptoms which require pharmaceutical intervention. A challenging example of this is that often panic or depression is perceived by the prescribing physician as the primary issue, when in reality it is obsessive worry!
Of course, chemistry is a complex subject, therefore; it is best to work with a skilled psycho-pharmacologist who can compliment the therapy. Be careful when prescribed medicine by a general practitioner because this professional has a limited understanding of co-morbid conditions.
I strongly suggest you go to the free library of clinical interviews at www. socialanxiety.com If you listen carefully you will hear gain important insight into the healing process, as well as, hearing testimonials. I challenge any therapist, hospital, university, or professional organization to come up with as much “evidence based” demonstrated clinical success!
Now we come to the final section of this introduction; your options for treatment and then the Andy Kukes Story.
The book “Beyond Shyness” was written in 1992. It provides an essential understanding of social anxiety. “Work Makes Me Nervous”, published in 2011 provides a state of the art and science self-help for social and performance anxiety at work.
The following audio programs are available:
Self-therapy for public speaking and performance anxiety.
Comprehensive self-therapy for social and performance anxiety.
Therapy is available in the Great Neck New York Office as well as internationally via telephone and skype.
Now the Andy Kukes story:
Andrew had a 4.0 average at Princeton and Columbia. He was good looking young man with everything going for him; except social anxiety. After many years of therapy with many different therapists, and after many attempts at healing, with medication, Andrew committed suicide!
In honor of his memory, Andrew’s family created The Andrew Kukes Foundation for Social Anxiety.
His father Jeff Kukes has stated that “we do not want what happened to Andrew to happen to another family”.
For the last 2 years I have been working with The Andrew Kukes Foundation to create “Social Anxiety: The Untold Story. This is a 10 hour plus documentary and training film. It offers what appears to be the most actual documented clinical success on film. Patients from around the country and experienced professionals have participated in this ground breaking and essential project.
This training film is now available for continuing education credits for mental health professions including psychologists, social workers, counselors, speech and language therapists, addiction counselors and more. If interested go to CMI Education or PESI online and search for “Social Anxiety: The Untold Story”.
Soon this film will be available to the general public for free. Yes for free. Donations are accepted. If interested go to The Andrew Kukes Foundation for Social Anxiety online.
I wish you a high performance mind and want you to know that with the right work social anxiety is truly resolveable!
July 16, 2012 – The recent tragedy where Brandon Thomas, a 20 year old college student, committed suicide opens the door for an improved understanding of a complex social anxiety disorder which currently impacts countless individuals of all ages worldwide. According to his parents, Brandon’s suicide was driven by his “unbearable blushing”.
Most medical professionals, including Dr. Enrique Jadresic, a Chilean psychiatrist, who was described in a recent MSNBC press release as the “world’s foremost expert in this area”, believe pathological blushing is an “involuntary response”.
Jonathan Berent, L.C.S.W. author of “Beyond Shyness: How to Conquer Social Anxieties” (Simon& Schuster), and “Work Makes Me Nervous: Overcome Anxiety and Develop the Confidence to Succeed” (Wiley), who has worked with thousands of social anxiety sufferers, stated today that he strongly disagrees with the term “involuntary response” as a comprehensive diagnostic.
Berent does agree with Dr. Jadresic that that “the social shame, which often accompanies blushing, can be devastating.” Berent has worked clinically with many patients with blushing, technically called “social anxiety-driven hyperhidrosis”, and has seen it lead to social avoidance, depression, and substance abuse. Berent adds “many patients who have been in treatment with me have considered a sympathectomy, or have had this invasive procedure, where nerves are cut to prevent blushing.”
Berent however intensely disagrees with Dr. Jadresic in his assertion that pathological blushing is an “involuntary response.” Berent states that “the psycho-physiological dynamics behind this disorder are crucial for the medical and mental health professionals to understand if clinical progress is to be achieved on any meaningful scale”.
The Magic Trick:
The Psycho-physiological “Mind Set” for Blushing Control
Patient x was an intelligent, attractive, athletic 20 year old college student who had recently been in a carjacking where he had been shot and almost killed. When he entered therapy with me it was absolutely incredible that this incident was hardly on his mind; what dominated his psyche was his uncontrollable blushing. This blushing, which had been present for many years, caused severe humiliation, shame, embarrassment, and depression. In addition it created substantial social avoidance, and relationship problems.
X was very motivated in treatment. We were able to do core work on self-esteem. Concurrent to this, we worked on the technique of adrenaline acceptance, which is a paradoxical mode of thinking to anxiety sufferers. X adapted the thinking that he was quarterbacking or piloting decision making and began to re-structure the defensive positioning associated with his anxiety.
One day in college when he was presenting a report in front of his class, he started by saying “guys; in a minute you will see a magic trick; my face is going to change color”. Guess what? He did not blush. Why; you are probably asking. The answer is because he went on offense (psychologically and behaviorally) instead of playing defense. By doing this he de-activated his psychological internal critical script that activated his autonomic hyper-sensitivity and the horrific visceral response associated with blushing.
Now don’t think that I suggest everyone implement this technique. It takes tremendous courage and substantial emotional work. The pathology of blushing is based on the sufferer’s belief that the blush is a character flaw and that when a blush occurs the flaw is revealed. Click here to listen to “Robert: Gifted Salesman” who describes two levels of anxiety during public speaking. Level one is “people can see I’m nervous”. Level two, which is deeper, is “people can see who I really am”.
The point I do want to teach is that when a proactive mind set is learned it can deactivate what appears to be an uncontrollable physiological reaction. It does take hard work! Click here for a detailed description of the Berent Method: High Performance Therapy for Social Anxiety”.
Click here to listen to “Kevin”, a lawyer who describes in detail how he learned to control his overwhelming hyper-hidrosis by controlling his internal critical script.
October 16, 2012
By Cortney Casey, C & G Staff Writer
The approximately 250 strangers conversing amongst themselves fell silent and turned their attention to Patty Kukes as she stepped to the podium on Sept. 27.
It was the kind of setting that would have constituted her son Andy’s worst nightmare. But that was precisely the point of “Misunderstood No More,” a presentation put on by the Andrew Kukes Foundation for Social Anxiety and hosted by Macomb County Community Mental Health Services.
“I’m very nervous today. I’m not a public speaker, but I’m up here in front of all of you,” said Patty Kukes, flanked by her ex-husband, Jeff. “Our son, Andy, couldn’t have even walked into this room. He had social anxiety — and it literally killed him.”
Andy, she said, “had every chance at a wonderful life.” He was an athlete, valedictorian of his high school class and a Princeton graduate. But even after seeking help from a series of therapists, he became virtually homebound “because he was so afraid of being judged, how his performance would be perceived,” she said.
Andy Kukes fatally shot himself July 14, 2009. He was 30 years old.
His suicide prompted the family — originally from Bloomfield Hills, now living in Florida — to launch a nonprofit organization in his memory in hopes of preventing future tragedies.
Social anxiety is particularly daunting to treat because it doesn’t manifest itself as obviously or outwardly as a severe physical injury or disease, yet its consequences can be equally grave, said Patty Kukes.
“If someone is blushing when they’re talking to you and sweating and very distressed and can’t look you in the eye, they’re sick on the inside,” she said. “Is it best to ignore that? Can we help them? Is it best to walk away?”
Social worker Jonathan Berent, who’s worked with social-anxiety patients since the mid-1970s, addressed those questions and more during the presentation, before a crowd of health-care professionals and laypeople at the Best Western Plus Sterling Inn Banquet & Conference Center Sept. 27.
As social anxiety is a disease of detachment, the key is getting patients to attach — which means they need to get comfortable with being uncomfortable, said Berent, author of “Beyond Shyness: How to Conquer Social Anxieties” and “Work Makes Me Nervous: Overcome Anxiety and Build the Confidence to Succeed.”
Social anxiety sufferers often develop a sense of hyper-vigilance in childhood, “a defensive radar that can cause burnout” as the nervous system works overtime, said Berent.
They start believing a never-ending internal script that tells them they’re inferior. Anxiety typically leads to avoidance, and sufferers often put off seeking treatment or turn to the Internet for “magic” remedies, he said.
Addressing adrenaline control is among treatment techniques, said Berent. Patients are encouraged to have realistic expectations: Instead of hoping an uncomfortable situation won’t spark an adrenaline rush, “accept the adrenaline-driven visceral response as a source of power and your friend,” he said.
Take one or two diaphragmatic breaths, then “surf” the wave of adrenaline instead of resisting it, he said.
“The surfer goes with the adrenaline; he or she is in control,” he said. “You do not go with it, you get smashed around. That’s a panic attack.”
According to Berent, working with enablers in the patient’s life also is crucial. If parents are contacting a therapist on their child’s behalf, they need to come in to get on board with the system of treatment, he said.
Besides events like the Sept. 27 community presentation, the Andrew Kukes Foundation offers two versions of a 10-hour intensive course helmed by Berent: one on DVD for professionals pursuing educational credits and one online for families, who can watch it for a donation, said Lori Blumenstein-Bott, the organization’s executive director.
Through its website, the foundation also is offering webinars with subject-matter experts, live-stream discussions with Patty and Jeff Kukes, questionnaires assessing social anxiety symptoms, aggregated relevant articles, links and other resources.
“Through awareness and education, the conversation begins,” said Blumenstein-Bott. “That’s how we want to build that message on a national level. The more lives you touch with this, the more people start talking about it.”
For more information on the Andrew Kukes Foundation for Social Anxiety, visit www.akfsa.org or call (561) 921-5151.
You can reach C & G Staff Writer Cortney Casey at email@example.com or at (586)498-1046.
The story of Rip Van Winkle is set in the years before and after the American Revolutionary War. In a pleasant village, at the foot of New York’s Catskill Mountains, lives kindly Rip Van Winkle, a colonial British-American villager of Dutch ancestry. Van Winkle enjoys solitary activities in the wilderness, but he is also loved by all in town—especially the children, to whom he tells stories and gives toys. However, he tends to shirk hard work, to his nagging wife’s dismay, which has caused his home and farm to fall into disarray. One winter day, to escape his wife’s nagging, Van Winkle wanders up the mountains with his dog, Wolf. As the story goes, he was given moonshine by the ghosts of Henry Hudson’s crew and slept for 20 years through the hardships, stress, and anxiety of the American Revolution.
To understand Rip Van Winkle Syndrome as a metaphor for social anxiety (2)and social avoidance it’s imperative to be clear about the variations in today’s world which are the equivalent of the moonshine that enabled Rip’s sleep. Also; keep in mind that when anxiety causes avoidance a phobia is present. When social anxiety creates avoidance social phobia is present!
Countless times when parents of dependents ages 16, 26, and 36 initiate treatment they communicate to me “We would have done something but we didn’t know what to do”. The result of this parenting confusion is “enabling”, which resulted in the child’s developmental and accruing social avoidance. This statement is not a knock on parents. It’s a fact about an insidious and very misunderstood anxiety disorder; social anxiety. Please be very clear. Adults with pervasive social anxiety and social avoidance rarely initiate treatment. They are stuck in the homeostasis of primitive functioning which is driven by the avoidance-dependence syndrome. For the most part the psychotherapy community does not understand this syndrome.
I am defining “primitive” as spending the least amount of energy possible to sustain baseline functioning. The primitive homeostasis is the default which characterizes the dependent’s lifestyle. The dependent learns that avoidance is better than experiencing the pain of social anxiety.
Let’s consider the moonshine which enabled Rip’s sleep. Patient X was an intelligent 26 year old a college grad with no social life, except one friend. He had no job. He played 70-80 hrs of video games a week. In the beginning stage of treatment he said to me “I wouldn’t know what else to do with my time” (other than video games). Video games became the anesthesia that enabled him to avoid the stress of life. It was his moonshine. Upon initiation of treatment this was his lifestyle for 5years. Not quite Rip’s 20 but on the way!
Patient Y is also 26. He has a very similar profile. Add to it binge drinking on the weekend and an involved relationship with marijuana. More moonshine. Y did have a group of friends he maintained since high school. The current relationship was totally based on weekend drinking.
Patient Z was an attractive 23 year old female. Her mom initiated treatment after watching The Bing Bang Theory on TV and identifying her daughter’s problem as selective mutism; the same as Raj on the show. Selective mutism is a variation of obsessive compulsive disorder. In essence; it’s a speaking phobia. Although very attractive and athletic, and a member of the college’s elite sailing team Z could not socialize without alcohol in college. In addition she experienced major anxiety in situations that required verbal performance and critical thinking without being dependent on mother.
XYZ are examples of hundreds and hundreds of the approximately 10,000 individuals with social anxiety with whom I have worked since 1978. If you are concerned about an individual with a similar profile understand that because of the social anxiety induced pain the sufferer chooses social avoidance rather than embracing interactive life. Sadly, such sufferers mistake true pleasure for the avoidance of social anxiety . The avoidance becomes a compulsion or addiction.
As Rip Van Winkle avoided the stress of life with moonshine, the adult with advanced social phobia escapes stress and anxiety via enabling and various dependencies. Therefore; if you relate to this article as an enabler, understand that in order to be good at avoidance you also have to be good at being dependent. You have the leverage to empower. What you need is a strategy.
“Debbie” is a 24 year old athletic blond with hundreds of young men pursuing her on a dating site. She is currently getting her Masters in Special Education. Her mother initiated treatment after Debbie experienced a stress breakdown at the beginning of graduate school. Because of the anxiety episode Debbie withdrew from school for a semester. While Debbie had always struggled with performance anxiety and an auditory processing deficit, no one pinpointed the selective mutism until mother and daughter were watching “The Bing Bang Theory” on television and identified with Raj, who had selective mutism.
In treatment Debbie was making progress with her social anxiety. She resumed her education and was functioning well at school. She was expressing herself well in classes. She started to reconnect with friends she had been avoiding for a long time. She controlled her relationship with alcohol, which had been characterized by binge drinking to get her through social situations. She started to date. This was especially important as she had been in a co-dependent relationship for a number of years.
Recently she shared a story. She got into a young man’s car after a first date. At one point this young man became too physically aggressive forcing Debbie to leave the car. In session I asked her how long she had been “talking” to this person via telephone. She responded; “a couple of weeks”. I asked “when you were talking with him did you get any read on chemistry”? At that point she explained that talking over the phone meant texting.
This is an insidious example of how avoidance of speaking on the phone, which was a symptom of her selective mutism, lead to over-dependence on texting. This resulted in no opportunity for a read on social chemistry, and a potential problem that luckily was averted.
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If you were walking down the street and you encountered a saber tooth tiger your fight or flight response would be activated. Every human being experiences the phenomenon of fight or flight. Fight or flight is driven by adrenaline. The social anxiety sufferer of any age experiences fight or flight upon interactive or social challenges. Fight or flight, when not controlled, creates panic. Fear of experiencing the adrenaline of flight or fight can create avoidance. Interactive avoidance caused by anxiety is a social phobia.
Common social anxiety scenarios that activate fight or flight include public speaking in formal situations, speaking in public in informal scenarios, fear of being noticeably nervous as in blushing, sweating, or voice stammering, interacting with an authority figure, socializing in general and so on. The common denominator is the fear of being judged.
The adrenaline control technique will help you control the fight or fight response and panic attacks.
Let’s go through the steps.
Step # 1. Have realistic expectations.
This means that your adrenaline will be present when experiencing the challenging situation. Let go of any hope or wish that the adrenaline will not be present. This reality is a crucial component of the physiology of performance. Here’s an example. I’ve done well over a thousand television and radio shows during my career; every kind of show possible; from “Opra” to “Opie and Anthony”. Now I like doing them for many reasons, but an interesting phenomenon always occurs. Approximate 30 or so minutes before a performance my hands get cold. This is vaso-constriction. It’s a build- up of anticipatory energy. I am not nervous. I’m anticipating. It’s adrenaline-driven energy waiting to be released. To me it means “ready set go” as I accept its presence with the interpretation that the adrenaline is my friend and source of energy. “Ready set go” is the opposite, or paradox, of the negative thinking that creates panic. Your adrenaline is going to be there. It’s a fact! It’s an integral force of the flight or fight response which every human being experiences. The paradox of embracing the adrenaline will create power instead of panic!
Step # 2. Accept the adrenaline.
This is the hardest. As I just said, it’s a paradoxical concept. Paradoxical means opposite. It’s a good bet that this is a totally different mind-set for you. Accept the adrenaline with the interpretation that it is your friend and source of power. Identify the very first sensation that you experience when you know that a adrenaline will occur–the very first physical or mental sensation that you experience. Please answer the question now. It’s at this point that your internal critical script usually kicks in with thoughts to yourself like “oh no”,” this is bad”, “I’ve got to get out of here”, and so on. It is at this point that you need to replace the critical thinking with acceptance. In order to make a change you need to be clear on the first sensation or symptom of distress. I’m certainly not saying this change is easy. You’ve probably been conditioned for the negative script for a long time. What I am saying is that replacing the negative with acceptance can be profoundly powerful. Learning his skill takes practice!
Step #3. Surf the wave.
In your mind’s eye create the image of a surfer surfing a wave. Your adrenaline is the wave. In order to achieve a successful ride the surfer goes with the wave. The wave is power. The wave is analogous to the adrenaline. Go with it and you will harness its energy and power. Going with it requires embracing the reality that it will be there. You have a choice. Acceptance it’s power by going with the wave and surfing it or.. Don’t go with it. Don’t accept it and the wave will smash you around; you will fall of the surfboard. Falling off the board is the equivalent of uncontrolled panic.
Step #4. 1 or 2 diaphragmatic breaths.
It’s one thing to know the steps conceptually. It’s another to implement them. This is where skills acquisition and you’re learning curve come into play. The productivity of your skills development will directly be related to proactive thinking and behavior. This is quarterbacking or piloting. In other words; the more you seek out adrenaline opportunities the more you will have the chance for to learn the skill. Passive thinking and defensive behavior will inhibit the learning process and basically get you nowhere. You are going to need to experiment in order to learn a new skill!
In 1976 fresh out of graduate school I was working as a youth worker in a community center. A colleague, with a background in special ed., suggested that we start a socialization group for teenagers with learning disabilities. I had no idea what she was talking about, but we conducted research and discovered there was no such service being offered. We set up a program where applicants would come for an intake interview with parents before participating in the group. An interesting thing happened. Many of the clients interviewed never showed up for the group. This is how I discovered social anxiety in the late 1970’s.
In 1978 I started a private practice specializing in biofeedback for stress related disorders. Soon thereafter I integrated therapy for socially challenged individuals as a specialty. This was the beginning of my clinical experience 37 years ago. Since then; I have facilitated treatment for thousands of individuals of all ages with social anxiety and related disorders. Treatment has included individual, family, parenting, and group therapy. The functioning level of patients has varied tremendously. I have worked with many superstars in their professions as well as pervasively challenged individuals.
I want to share with you what I have learned regarding treatment efficacy!
First; in a private practice setting if you do not help your patients achieve their goals they will not come to therapy. Secondly; given that social anxiety is the quintessential disease of resistance, a creative and productive approach to treatment was necessary for productivity. The result was the Berent Methodology, which has been crafted, developed, and organized for 37 years.
The Berent Method has customized a treatment methodology adapted to the specific needs of social anxiety rather than fit the problem into the confines of existing modalities. This is the most important concept of this essay. The Berent model has integrated various functional psychotherapeutic modalities into it’s’ system as important tools for learning.
The starting point of treatment for social anxiety is to understand that while there are many manifestations of social anxiety there are 2 basic types of people with the problem. The 2 types are Individuals with “initiative, and individuals without “initiative”. Initiative does not mean ability it means the motivation to start up. I have not seen this variable factored into any formal research that demonstrates clinical efficacy.
For example, there is a substantial difference between the 26 year old who is experiencing relationship challenges and performance anxiety at work who initiates treatment independently vs. the 26 year old who is holed up in his room playing 100 hrs. of computer games a week and the parent initiates therapy . The fact that mental health technologies have not differentiated between the 2 basic subgroups (initiative vs non-initiative ) is a major component of the trivializing of social anxiety.
The term “evidence based” is often used for clinical marketing. The problem is that most evidence for social anxiety treatment success is quite limited. If you are going to take advice from someone it’s good to have evidence of that person’s performance. I encourage you to experience real evidence by accessing the free library of clinical interviews at www.socialanxiety.com. In fact, I challenge any therapist, hospital, university, or organization to come up with more evidence of clinical success for social anxiety!
The biggest confusion that people bring into treatment is a lack of understanding about how ingrained the problem can be. In order to understand “ingrained” it’s important to understand the architecture of the disorder.
The problem is multi-dimensional. It includes the following domains:
F. Function = physiology
A. Action = behavior
T. Thinking = cognition
Integrating FATE into treatment is essential if the objective is to resolve the core issues and to develop a “high performance mind”, which I define as proactive energy to achieve happiness and health. The two dynamics that are most absent from treatments in general for social anxiety are an understanding of the relationship of emotion to physiology and the avoidance-dependence syndrome that impacts individuals without initiative.
When my first book “Beyond Shyness” was published in 1992 by Simon & Schuster I had experienced a number of rejections by publishers. They had asked “you are writing a book about shyness why are you writing about parents”. My writing about parents was a sign that I developed a strategy to negotiate the avoidance-dependence pathology. This pathology can run very deep and is often the core of resistance. Avoidance often evolves into a compulsion or addiction.
I have been criticized by a few individuals for not having compassion for social anxiety sufferers. These people are incorrect. What they are witnessing is my energy needed to negotiate narcissistic-driven avoidance. I will discuss more on this personality dynamic at another time. At the risk of creating controversy I will tell you that too much compassion is an ingredient for the chemistry of enabling.
The philosophy behind the Berent Method is that time is your most valuable asset. Time is not elastic. It doesn’t stretch. Social anxiety accrues with time. The negative and painful mind-body response of social anxiety gets worse the more it remains the same. The average age of my patients since 1978 has been in the late 20’s. It’s extremely gratifying to work with young children as there is an opportunity to prevent the anxiety from becoming avoidant or dependent personality disorders. While the anxiety response can be very ingrained at age six, It’s much less than 26, 36 46 or 56.
Let’s first consider social anxiety without initiative. All children and most teenagers with social anxiety do not have initiative. Common examples include selective mutism, school phobia, and teenagers and adults who are pervasively avoidant and dependent.
Where initiative is not present treatment is parent focused. The goal is to empower vs enable. Parents are guided into parenting team building and teaching the dependent emotional intelligence. The concept of nurturing, which had been defined as rescuing, is re-architected into providing support and promoting growth. A crucial component of treatment is helping parents negotiate their own emotions and anxiety through the process. Adolescents and adults are integrated into therapy sessions after parents have learned appropriate skills. In the case of young children treatment is totally parent focused.
Now let’s consider treatment for social anxiety patients with initiative. Treatment is a combination of technique and core work. After a comprehensive orientation and history taking individuals are introduced to the concept of mind states. Based on the psychology of transactional analysis mind states is a productive tool in making concrete the therapeutic process. You can see that the therapeutic objective is to increase the “nurturing parent”, “adult” and “natural child” while decreasing the “critical parent” and “adapted child”.
The primary technique in the Berent model is the paradox of making friends with adrenaline. This requires a historical analysis of how the negative association to adrenaline was learned. This is concurrent with learning to accept and surf the wave of adrenaline. This technique will help to channel and harness the energy of adrenaline. Skills are implemented developmentally and are applied to the patient’s behavioral hierarchy of anxiety. This is where there is potential for immersion as a component of the behavioral strategy
Core work is based on The Sarno Method. John Sarno MD is world renown for his work with back pain and the “Mindbody Prescription”. The basic Sarno dynamic is that repressed anger and rage is the root cause of physical symptoms. This rage is so strong that it inhibits the flow of oxygen into the blood stream. This methodology facilitates an understanding of one’s “reservoir” (the unconscious memories). In the reservoir are the root causes of shame, embarrassment, and humiliation. Once the reservoir has been identified the goal is to attach on an emotional vs intellectual level. In mind state transactional analysis language the more that the natural child has not been nurtured, the more repressed rage there will be!
One of the questions you are probably asking is “how long does treatment take”? The answer depends on ones learning curve. The primary variables to the learning curve include length of the problem, severity of the problem, degree of obsessive energy, motivation, expressive ability, the ability to integrate new concepts, and readiness to face fear.
Pharmaceutical intervention is utilized when indicated. When used; the philosophy is to use the medicine as a tool to help facilitate the therapeutic process.