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This training presentation provides clarity regarding
a pervasive and grossly misunderstood anxiety disorder.
This technical paper explains how perfectionism is the core dynamic which causes, and drives, social and performance anxiety in thousands of cases.
During my career which has spanned thirty eight years, during which I have provided clinical services to literally thousands of patients of all ages with social anxiety, I have discovered that the biggest source of confusion for sufferers is understanding how ingrained the problem becomes. Adding to this confusion are marketing efforts and promises from the behavioral therapies; especially cognitive behavioral therapy, which states it is the “golden standard for treatment” for social anxiety. This statement is based on a gross over-simplification of the problem! The clinical reality is that a treatment architecture which basically dismisses the importance of the emotion-physiology; relying only on cognition and behavior, will reach the point of diminishing returns for most social anxiety patients. The following article offers insight.
<h3><strong><a href=”http://psychcentral.com/lib/toward-an-understanding-of-reservoir-implications-in-the-treatment-of-social-anxiety/?all=1″ target=”_blank”>Click Here to Read Article</a></strong></h3>
“Just the Way I Am”: Denial Is the Enemy of Social Anxiety Sufferers
Confessions of an “Avoidance Addict”
By Amy Lemley
No one would ever call me shy. In fact, I am “the extrovert’s extrovert,” an attention-seeker, a ham. I love public speaking, being interviewed on television and radio, and having my picture taken. I talk to strangers. A lot.
Yet through it all, I have suffered from extreme social anxiety. And I’m not alone. An estimated 37 million people suffer from it in the United States alone. You know some of us, though we are so adept at covering up our fears that you might never suspect.
We are crippled at times by symptoms such as obsessive worry, a racing pulse, clammy hands, and blushing and sweating to such an extent that we’d rather be alone than suffer—no matter what the cost. We may sacrifice relationships. We may sabotage our own careers. We may self-medicate with alcohol and drugs.
However we respond, we do so under a veil of denial wrapped so tightly around us that we cannot move. We don’t know what is wrong. We don’t know there’s a name for it. Our secret is so shameful, our self-hatred so deep, and our belief in our power to change is so diminished that we feel hopeless and unworthy.
“It’s just the way I am…”
Many social anxiety sufferers are labeled “introverts” or consider themselves to be “just shy.” In their view, this is just how they are, an indelible part of their personality. But according to the Andrew Kukes Foundation for Social Anxiety, which reports that one in eight people suffers from social anxiety, a limited awareness of exactly what social anxiety is and how to detect and treat it sentences some people to a life of “less than”—less than happy, less than comfortable, less than successful. (more…)
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.