Exposure therapy

phobic SG

Exposure Therapy

Exposure therapy is essential if you are to overcome your social anxiety, ie you must put yourself in the social situations you are worried about. Although this sounds frightening, your therapist will give you the tools to cope with confronting your fears (e.g. rational thinking, slow breathing & isometric relaxation)

The exposure sessions must be

graded

repeated and regular

prolonged

Graded:
Your therapist will work with you to determine what would be an appropriate first step; it should be difficult enough to provoke some anxiety but easy enough for you to be fairly confident you can do it. Once you can cope with Step 1 confidently, then you can move onto a more difficult situation and gradually work up your most feared social scenarios.

It is important not to confront a feared situation that is far too difficult for you, as if you tackle something too stressful, without sufficient preparation, you may become extremely anxious or even have a panic attack. Such a negative experience would only strengthen the association between fear and the social setting.

Repeated:
You need to confront your feared situations frequently and regularly if you are going to overcome your anxiety. If your exposures are too far apart your fear will have risen again by the next time you do it.

Prolonged:
Generally, it is advised that you stay in the feared situation until your anxiety starts to decrease. Socially anxious people often approach or attempt a feared situation but then choose to escape from the feared social or performance situation. When you avoid or leave feared situations your fear of them increases because the decrease in anxiety which follows escape gives you the idea that avoidance was a helpful strategy. However, if you stayed in the feared situation your anxiety would eventually decrease and the next time you confronted the situation you would be less anxious.

Therefore, it is important to your recovery that you stay in the social situation you are attempting. Try not to panic or flee if the anxiety becomes severe. If your anxiety is high, you may feel you temporarily need time out from your feared activity, e.g. if you were attending a house party you might go to the bathroom or sit outside in the garden, do some slow breathing, develop some rational thoughts and wait for the fear to decrease for going back into the party,

Remember exposure is necessary for your recovery.

phobic SG

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 criticism. 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 (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 of their lives, either from a specific social phobia or from a more generalized social phobia. In the United States, epidemiological studies have recently pegged social anxiety disorder as the third largest psychological disorder in the country.

A specific social phobia would be the fear of speaking in front of groups, whereas generalized social anxiety indicates that the person is anxious, nervous, and uncomfortable in almost all (or the majority of) social situations.

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, particularly with strangers

Making "small talk" at parties

Going around the room in a circle and having to say something

This list is certainly not a complete list of symptoms -- other feelings may be associated with social anxiety as well.

The physiological manifestations that accompany social anxiety may include intense fear, racing heart, turning red or blushing, dry throat and mouth, trembling, swallowing with difficulty, and muscle twitches. 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" sense. Nevertheless, "knowing" something is never the same as "believing" and "feeling" something. Thus, in people with social anxiety, thoughts and feelings of anxiety persist and show no signs of going away.

The good news is that cognitive-behavioral therapy for social anxiety disorder has been markedly successful. People who have had this anxiety problem for long periods of time have blossomed while in therapy. After therapy, people with this problem report a changed life -- one that is no longer totally controlled by fear and anxiety.

Social anxiety, as well as the other anxiety problems, can be successfully treated. It always bothers me when I read that a person with social phobia is just going to "learn to live with it". I want to scream. "No! You don't have to live that way!"

But in seeking help for this problem, search for a specialist -- someone who understands this problem well and knows how to treat it. Become an informed client and ask questions. Do they understand that you feel very self-conscious, that others are watching and forming a negative evaluation about you or do they minimize what youre saying and just say, "No, No, No, youre exaggerating...." Now it is true that we who have gone through social phobia do realize our mind is overexaggerating, but it still FEELS like others are watching and judging us. Our self-consciousness is very real. If your psychologist/mental health care worker does not understand this, YOU KNOW MORE THAN THEY DO ABOUT SOCIAL ANXIETY. It is very doubtful they will be able to help you.

Also, remember that the true professional will always welcome your questions. If they seem stand-offish and unfriendly, 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 progress through therapy. Remember: This is YOUR time to get better and heal. This is YOUR time to move forward away from the effects of anxiety, fear, and avoidance.

continue in next post ...

phobic SG

Do they run a behavioral therapy group just for people with social phobia? This is essential. If there is no social phobia therapy group involved, seek treatment elsewhere. A behavioral therapy group is essential to your ultimate success. (Note: We are not talking about a "support" group -- what are we supporting anyway? The continuance of social phobia? Support groups for people with social phobia do not help people overcome this anxiety disorder. In fact, they may actually prevent progress.

Secondly, the group should not be a mixed anxiety group. Although the anxiety experienced by all people with anxiety disorders is somewhat similar, people with social phobia need precise, custom-tailored group activities run by a specialist in this area. A social phobia therapy group should only be for people with social phobia.

Getting over social anxiety disorder is not an easy task; yet many thousands have already done it. While youre in the middle of the problem, it feels hopeless that youll never ever get better. Life is just one gut-wrenching anxiety problem after another.

But this can be stopped, quenched, and reduced in a relatively short period of time but you must find a cognitive-behavioral therapist who understands and specializes in the treatment of social anxiety.

The most important elements in conquering social phobia are:

1. An understanding and awareness of the problem,

2. A commitment to carry through with cognitive-behavioral therapy even when it seems difficult,

3. Practice, practice, practice to get that information deep down into your brain so that it becomes 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 anxiety-free 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: We use a ladder or "hierarchy" as a flexible guide in our 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. WE DO NOT PRESSURE, PUSH, or CAJOLE. NO NEGATIVE tactic is 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, thats O.K. No one will ever force her to do or say a thing. But heres the secret: This has never happened! Everyone in the group understands why they are there and, despite an amount of anxiety that is present, they voluntarily choose to work on their specific anxieties. This is much more practical and real-life than being forced to do something in a group. While the therapist and the group should be encouraging and motivating, the ultimate decision on progress resides within the person himself.

Therapy groups should always be encouraging, positive, and supportive. Social anxiety people are among the nicest people in the world. Go to a meeting and find out......

It is impossible to stop a motivated person who refuses to give up practicing. 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 than your therapist.

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 doesnt do us any good. Instead, we focus on present-day problems and symptoms and use many small techniques and methods to eradicate anxiety thinking.

Heres 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 conquered.

-- Thomas A. Richards, Ph.D.,
Psychologist

phobic SG

More on exposure therapy

An estimated 19 million Americans suffer from life comprising phobias. The two major types of phobias are social phobia and specific phobia. People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations. Those with specific phobias experience extreme and disabling fear of a specific object or situation such as driving or flying. Phobias can lead to avoidance of many potentially pleasurable and meaningful activities, and cause people to restrict their lives unnecessarily.
A phobia is an irrational fear, and all phobias have a commonality in faulty thought processes that bring on unbearable physical symptoms. This is part of the bodys innate flight or fight response, which is an internal self-preservation mechanism that secretes adrenalin within the body to help one survive a life-threatening situation. The problem is when your brain registers a threat when there is no real danger. It nonetheless tries to protect you by scaring you into safety. The first instinct is to avoid feeling discomfort, and avoidance is what maintains and fuels the phobia. A phobia can develop in association with people, things, situations, objects, animals you name it. There are hundreds of recognized fears. Some of the most common phobias are of public speaking, flying, driving, heights, and elevators.

Most people with phobias were born with a more sensitive nervous system that predisposes them to experience anxiety more intensely. On a positive note, those who are prone to anxiety and phobias also tend to be conscientious, responsible, highly intelligent, imaginative, and very creative. This is why theyre so good at creating catastrophic mental scenarios with such vivid detail, and why they worry so much about what other people think. It is also why theyre so good at disguising their fears with seemingly logical excuses such as Sorry, cant go to the restaurant, just ate. Some will strategically plan a safe route to go the office, while others will take the stairs for exercise, rather than be confined on an elevator. The brain doesnt know the difference between a real or imagined event, so ones imagination is enough to make the body release adrenalin. A spurt of adrenalin usually lasts only 10 minutes, so it takes a certain amount of creativity to sustain a high level of anxiety for long periods of time. Adrenalin can cause a whole host of symptoms such as a racing heart, shortness of breath, excessive sweating, inability to think clearly, and dizziness to name a few. An adrenalin rush is helpful if you need to run or fight for your life, but unproductive in most day-to-day living situations. In fact, it can leave you feeling frazzled and out of control. Its important to realize that youre not going crazy. You may feel that way because the very real physical symptoms you experience can be overwhelming. The good news is that phobias can be cured.

http://www.suite101.com/article.cfm/all_about_anxiety/109927

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phobic SG

Phobias are successfully treated by challenging, and changing catastrophic thought patterns, while gradually exposing yourself to your feared situation. This helps break the automatic response pattern. Also, reducing your sensitivity to adrenalin will help to minimize the severity of the anxiety symptoms.

First you want to become aware of what thoughts and messages you say to yourself on a daily basis. We often run on autopilot, and panic seems to come from nowhere. Carry around a small notebook or journal to log your thoughts throughout the day, particularly when youre starting to feel anxious. As you become aware of the irrational belief underlying an automatic thought, you can begin to challenge these beliefs by examining the evidence for them, and looking for alternate explanations to take its place. Phobias tend to be plagued by what if thinking. Instead of what if, learn to adopt the phrase So what if!. By gradually changing what if thinking to so what if thinking, your phobia will eventually lose its power.

Once you identify what triggers your anxiety (i.e., talking to authority figures, being confined in small spaces like an elevator, dizziness in supermarkets), the next tool is to develop a 10-step hierarchy designed to gradually expose yourself to your feared situation in small increments. For example, if youre afraid of public speaking, you may want to begin step 1 by making a one-sentence comment in a small group, step 2 could build up to 2-3 sentences in a small group, until you reach step 10 - your most feared action of giving a long talk to a larger audience. Determine your level of distress by rating your fear on a scale of 1-10. Rate your level of anxiety each time you practice a step on your hierarchy. Spend as much time as you need on each step, and dont move on to the next step on your hierarchy list until you can master the previous task consistently below a level four.

Hierarchies can first be done by using mental imagery to visualize yourself achieving each task. Eventually youll actually confront your fears in a safe controlled way that minimizes your anxiety, while building your confidence. Try not to push yourself to the point where your anxiety becomes too unbearable. If it begins to get too overwhelming, allow yourself an out. Its also very helpful to keep a record of ALL your successes, no matter how small you think they are. Your successes are what diminish your phobia over time.

Since most people with phobias have a sensitive nervous system, its important to reduce your sensitivity to adrenalin. If youre feeling stressed, anxious, rushed, or have low blood sugar from not eating, it will only exacerbate your anxious symptoms when in a feared situation. The more you can do to help yourself relax throughout the day, the less intense the anxiety will become.

Daily exercise is a great way to burn up excess adrenalin, which will also make you more resilient to the effects of adrenalin. Try to avoid or reduce any substances that mimic adrenalin such as caffeine, nicotine, alcohol, and marijuana. Sometimes alcohol & marijuana are used to reduce anxiety, but ultimately it comes back with a vengeance and makes it worse. Diaphragmatic breathing, which is breathing from your stomach, is another tool that helps to calm the nervous system. (See article: Breathing: Stimulant or Sedative?) Shallow breathing, which is commonly done when anxious, actually revs up the nervous system and releases adrenalin. Also, eating small meals throughout the day helps to keep your blood sugar stable. When you go long periods of time without food, your blood sugar drops and this cause adrenalin secretion.

If your anxiety is severe, there are many types of medication available to help reduce the intensity of your symptoms. Medication wont cure your anxiety attacks, but it can help manage your symptoms so youll be able to use the tools that will ultimately extinguish your phobia.

While you practice your steps and life changes, remind yourself that youll be okay, that youve experienced anxiety before and survived. What would you say to a friend in your shoes? Be just as kind to yourself as you work through each step. Set-backs are all part of the process, and can only occur when some progress has been made. Its not a sign of failure. You only fail when you stop trying.

phobic SG

LITANY AGAINST FEAR

I must not fear.
Fear is the mind-killer.
Fear is the little-death that brings total obliteration.
I will face my fear.
I will permit it to pass over me and through me.
And when it has gone past I will turn the inner eye to see its path.
Where the fear has gone there will be nothing.
Only I will remain.

from Frank Herbert's Dune

This may be a helpful distraction during exposure. Originally posted by the bear.

phobic SG

By the way exposure therapy is effective for other types of phobia as well.

http://www.sgforums.com/?action=thread_display&thread_id=2971

somepersonlah SG

it will definitely help overcome your fear..