Actually, avoiding parties, friends, meetings, and other social situations because you get too anxious about them is a big deal. It’s a coping mechanism for an anxiety disorder called social anxiety disorder.

Social Anxiety Disorder: Signs and Symptoms

Social anxiety disorder is very common, affecting around 15 million adults in the United States, and its symptoms can be more subtle than you might think.

“It’s one that is often not detected by patient or doctor. People devise their lives unconsciously and consciously so as to not recognize the presence of the disorder,” says Charles Goodstein, MD, a clinical professor of psychiatry at New York University Langone Medical Center.

“But for some people like that, it becomes an important limitation as opposed to having some sort of clear-cut malfunction. They’ve somehow sidestepped what the real problem is. What we see is a defense against the anxiety rather than the anxiety itself,” says Dr. Goodstein.

Social situations can certainly be nerve-racking, but most people just deal with the temporary discomfort and anxiety because they enjoy other aspects of the interactions. But not everyone can set their anxiety aside.

People with social anxiety disorder feel an overwhelming level of anxiety as well as self-consciousness in certain or even all social settings; they are often convinced that all eyes are on them, watching and waiting for them to make a mistake. Their anxiety about an upcoming event can start weeks in advance. Like certain other forms of anxiety disorder, physical symptoms can show up as well. In addition to sweating, they may experience nausea, difficulty talking, and blushing.

“A social situation always carries risk to some extent when the situation involves people that you don’t know, groups around you that you can’t scan adequately. Most people make an adaptation to it, more or less,” says Goodstein. But for people with social anxiety disorder, it’s terrifying to think about being in a situation for which they can’t prepare or any unknown where they can’t gauge what their response will be, according to Goodstein.

“The anxiety level rises tremendously, and very often you hear that in the middle of giving a talk, for instance, they feel they have to walk off stage. They may feel palpitations or feel that they are going to sweat — and that this is something they have to avoid,” says Goodstein. For people with social anxiety disorder, avoiding the situation seems the sensible thing to do, rather than run the risk of embarrassment.

Social Anxiety Disorder: Causes, Diagnosis, and Treatment

The causes of social anxiety disorder aren’t well understood. Being extremely protected throughout childhood and adolescence may be related to some cases. Social anxiety disorder may be caused by genetics. It often occurs in conjunction with other anxiety disorders and depression, and often results insubstance abuse.

To diagnose social anxiety disorder, a doctor will evaluate your symptoms and situations in which the anxiety occurs. He will also look for physical symptoms of social anxiety disorder, including increased heart rate and blood pressure levels.

Social anxiety disorder can be treated using therapy to help confront fears, first mentally and eventually physically in real circumstances. Antidepressant and anti-anxiety medications may also be given to help manage social anxiety disorder.

Social anxiety disorder is common, but just because you find yourself a little shy or nervous sometimes doesn’t mean that you have the condition. However, if you start avoiding certain situations, and find that your anxiety is really affecting how you live and function, you can learn to manage your social anxiety disorder and regain control over your life.

• communication problems
• infidelity
• balancing the demands of home and work
• misbehavior or school problems in a child
• the loss of a family member
• childhood traumas
• conflicts in blended or remarriage families
• step-parenting problems
• family violence, or
• substance abuse

You may also wish to see a family and couples counselor to enhance your family relationships by learning such skills as effective communication, conflict resolution, assertiveness, and time management.

Marriage and Family Counselors practice in a variety of settings, including independent practice, community mental health agencies, managed care organizations, hospitals, employee assistance programs, and houses of worship. They may provide any of the following services:

• assessment and diagnosis
• individual, couples, and family counseling
• prevention programs and parent education programs
• crisis management
• multi-couple or multi-family groups

If you would like to contact a Marriage and Family Counselor:

1. Get a referral (advice on who to contact) from someone you trust.
2. Check out the counselor’s credentials. Marriage and Family Counselors have at least a master’s degree, receive supervised experience following graduation, are licensed or certified in 40 states, may be certified by such organizations as the National Academy of Certified Family Therapists and follow ethical codes.
3. Make sure the counselor has experience in working with the difficulties you are encountering.
4. Ask about payment options.
5. Consider interviewing more than one counselor to find a good fit for yourself and your family.

During your first visit, your counselor should discuss the following:

• inform you about what to expect from counseling
• inform you about their credentials and experience
• discuss treatment methods
• discuss fees and scheduling

Most importantly, you should feel as though the counslor is someone you can trust, someone who respects you. You should feel safe and be able to talk about what bothers you most. Feeling respected and safe may include receiving a prompt return phone call when you first contact the counselor. You should also feel that the counselor has time for you, is able to schedule appointments when you feel the need for them, and is on time for sessions. Sexual intimacy between counselor and client is never appropriate.

Your counselor should respond to your concerns in a caring and helpful way. This includes careful listening and working ttogether to set reasonable goals. You should feel hopeful about the counselor’s ideas about how to help you and your family.

Payment options include direct payment, reimbursement by an insurance company, or participation in a managed care plan. Ask your counselor about the advantages and disadvantages of each payment plan.

Additional information regarding how to find a counselor and ethical practices of counselors can be found on the American Counseling Association’s web site: http://www.counseling.org/consumers_media/.

Reprinted with the kind permission of International Association of Marriage & Family Counselors.

Finding a reputable counselor is hard enough without adding the extra trick of finding one online. Let’s go about this in an organized fashion.

If you do not have a recommendation from your doctor you can let your fingers do the walking in the yellow pages of your local telephone directory. But how secure is that? After all, anyone can place an ad in the yellow pages.

Online you should be able to search out a lot more information about any given psychologist, therapist or counselor. The more details you can find the better off you will be in making an already difficult choice. So, put the phone book away and begin your journey in whichever search engine you like to use.

Online you also get directions and photos or images to help you along the way. Want a place close to where you live? That would be smart too. When searching put in your city and state after the search term. You will need local results. Just make sure you follow these guidelines.

Look for and Read Detailed Information

Does the web site have enough detail to tell you about the counselors in question? Look for lots of personal information. A professional is not afraid to tell you who he or she is and about their formal education and professional history. Short generalized descriptions do not really tell you anything and are not useful information.

Look for Diversity of Services

Find a group that offers different kinds of therapy solutions. If you have never seen a mental health counselor before and are unfamiliar with the language, read the articles on this web site to help you get a handle on some of the types of therapies available.

How to Search “Smart”

Use specific terms and add “counseling,” “counselors” or “therapy,” “therapists” and your city, state at the end of the word or term. These are examples of keywords and key phrases to use in a search engine:

depression counseling New York, NY
ADHD counselors Los Angeles, CA
panic disorders counseling Wichita, KS
aspergers therapists Minneapolis, MN

This should be enough to help you get started. Be sure to get referrals from your M.D. if needed for your particular type of insurance coverage.

The RIGHT Kind of Counselor

Find a counselor who devotes their time to their patients and not dishonest search engine tricks or study in how to fool search engines and all the “black hat” items listed above.

A professional counselor will not spend their time worrying about their web site. Professional counselors hire the right people to handle their online marketing issues using only “white hat” techniques. Meanwhile, they will be helping their patients gain a happier, healthier and more productive life.

Play therapy is generally used with children ages 3 to 10. Play provides a way for children to express their experiences and feelings through a natural, self healing process. Because children’s experiences are often communicated through play, it becomes an important vehicle to help them know and accept themselves.

Play Therapy, according to the Association for Play Therapy, is the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development. A lay definition might be a form of counseling or psychotherapy that therapeutically uses the power of play to communicate with and help clients, especially children, to achieve optimal mental health.”

Play therapy is often used as tool of diagnosis. A play therapist observes a client playing with toys (play-houses, pets, dolls, etc) to determine the cause of the disturbed behaviour. The objects and patterns of play, as well as the willingness to interact with the therapist can be used to understand the underlying reasons for behavior both inside and outside the session.

According to the Psychodynamic approach, children will engage in play behaviour in order to work through their anxieties. In this way play therapy can be used as a self-help mechanism, as long as children are allowed time for ‘free play’. From a developmental point of view, play has been determined to be an essential component of healthy child development. Play has been directly linked tocognitive development.

One approach to treatment, is for play therapists use a type of systematic desensitization or relearning therapy to change the disturbing behaviour, either systematically or in less formal social settings. These processes are normally used with children, but are also applied with other pre-verbal, non-verbal, or verbally-impaired persons, such as slow-learners, brain-injured or drug-affected persons. Mature adults usually need much “group permission” before indulging in the relaxed spontaneity of play therapy, so a very skilled group worker is needed to deal with such guarded individuals.

Many mature adults find that “child’s play” is so difficult and taboo, that most experienced group workers need specially tailored “play” strategies to reach them. Competent adult-group workers will use these play strategies to enable more unguarded spontaneity to develop in the non-childish student.
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article “Play Therapy”. – http://en.wikipedia.org/wiki/Play_therapy
The Play Therapy article is a stub contributed by ERIC Digest.

EMDR stands for “eye movement desensitization and reprocessing.” It is a procedure used in psychotherapy to help you reduce the impact of experiences from the past that intrude on your present-day life. Often, these experiences from the past involve a trauma such as assault, abuse, an accident, or a natural disaster. Even though the trauma may have happened many months or even years ago, you still feel its impact in your daily life through post-traumatic symptoms such as intrusive memories, emotional flooding or numbing, nightmares, anxiety, low self-esteem, and difficulty getting on with your life. EMDR has also been used to help people deal with anxiety and panic problems, grief issues, reactions to physical illness, and many other conditions where strong emotions are associated with life experiences. EMDR has proven effective in the treatment of post-traumatic symptoms in several research studies.

The Problem with Trauma
In daily life, we all use our minds to figure things out, cope with predictable stresses, and regulate our emotions and our self-esteem. The experience of trauma overwhelms our capacity to cope, and the trauma experience often gets stored in our minds in ways that make it very difficult to use our usual ways of coping. For example, even though we know that a traumatic event happened in the past, it becomes impossible for us to think about it without starting to feel emotions and other sensations that occurred at the time of the original experience.

We also typically develop a negative way of thinking about ourselves in relation to trauma, such as “It’s my fault” or “I’m a bad person.” These negative thoughts often influence how we think and feel about ourselves in other situations. EMDR attempts to activate your coping skills to deal with the present-day impact of the trauma. The EMDR procedure can help desensitize the images and feelings associated with the trauma. It can help you to recognize and work on feelings and thoughts that come up with the trauma. And it can help you think differently about yourself in relation to the trauma.

The EMDR Procedure

The therapist will talk with you about yourself in an effort to understand the history of your difficulties and how they are affecting your current life. This may take one or two sessions. If EMDR is recommended, your therapist will explain the procedure. If you decide to go ahead with it, you and the therapist will construct a description of your problem that includes: an image or picture that represents the past event, your negative beliefs about yourself in relationship to the event, how you would prefer to think about yourself in relation to the event (positive belief), your emotions associated with the event; and your physical sensations associated with the event. You will also be asked to give numerical ratings to your degree of upset and the credibility of the positive belief so your progress can be monitored during the session.

After the protocol described above is established, you will begin the processing phase of the procedure using the eye movements (or other kinds of bi-lateral, rhythmic attentional stimulation, if eye movements are not appropriate in your case). A typical EMDR processing session lasts from 50-90 minutes. During this part of the treatment the therapist will be sitting beside and facing you. The therapist will ask you to bring to mind the picture of the experience that is bothering you along with the negative self-thought, the emotions, and the physical sensations. You will be asked to hold this in mind as best you can while following with your eyes the therapist’s fingers, which are moving back and forth. After a series of about 30-50 eye movements (or more), the therapist will ask you to stop, let go of the image (or thought) for a second, take a deep breath and then notice and describe briefly what thoughts, feelings, images and body sensations arise for you. Usually, the therapist will ask you to go on with those thoughts, feelings, images and sensations and will do another set of eye movements.

You will go through this process of moving your eyes, pausing, and reflecting several times during the session. Typically, the images, emotions, and sensations you experience change as you go through this process. Assuming that your thoughts, feelings, images, and physical sensations become less distressing, the therapist will ask you to bring up the positive self-statement and will use EMDR to help you begin to associate this new way of thinking about yourself with the original troubling image. If your level of upset continues to be high toward the end of the session the therapist will work with you to help you to calm down and prepare you to continue your work at your next session.

You and your therapist will often know if EMDR is going to be useful to you in one or two sessions. It’s hard to predict, in general, how long EMDR treatment will take. You may experience sufficient relief from your symptoms in as few as two to six sessions or EMDR may be a procedure that you and your therapist use as part of a longer-term therapy process for several months to deal with certain problems and issues.

Cautions

EMDR processing can be upsetting. There are many safety procedures built into the EMDR process, but it can still be an intense experience. The aim of each EMDR session is to help you feel less upset at the end of the session. But sometimes it’s hard to work through a difficult issue even in a 90-minute session. If staying upset or becoming upset after a session becomes a pattern for you, you should tell your therapist that this is happening. In EMDR, you might remember events or parts of events you either hadn’t thought about before or hadn’t associated with the problem being worked on. Memories coming up in EMDR are no more or less accurate than any other memories that our mind constructs when reflecting on the past. Regardless of the absolute truth of the memories that emerge, they usually bring up important psychological issues that can be processed in EMDR.

You shouldn’t undertake any course of treatment, EMDR included, where your life circumstances and financial resources will not allow you to work safely and bring the therapy to a reasonable conclusion. Even though EMDR can tield results in a short time, you need to be prepared to follow through with a course of treatment.

You should only undertake EMDR treatment with a therapist who is credentialed to do psychotherapy and who has special training approved by the EMDR International Association (EMDRIA). As with any psychotherapy, you should feel comfortable with your therapist. You should feel free to ask about your therapist’s EMDR training and his or her general experience in working with difficulties such as yours.

DBT skills training teaches powerful self regulation and interpersonal skills that can interrupt patterns of self-destructive and self-defeating behavior. The goal of DBT is to help clients to develop the skills to create “a life worth living.”

The group focuses on the DBT skills of:

• mindfulness
• interpersonal effectiveness
• emotion regulation
• distress tolerance

This sixteen-week group is an abbreviated version of the standard 24-week DBT skills group—clients are welcome to repeat the group for more intensive training.

New clients are expected to complete a screening interview, to commit to attend the entire sixteen weeks, and to complete out-of-session behavioral homework.

More Details

The group is designed for older adolescent and adult clients with emotional regulation and interpersonal problems. In most cases, we expect clients to continue working with their individual therapist while they are attending the group.

The group meets on Thursday evenings from 6:00 PM to 7:30 PM. After completing the initial screening interview, it is possible to join the group at the beginning of one of the skill modules. Please contact BMSPA for possible start times.

Many insurance providers will pay for this treatment as part of an intensive outpatient program or as group psychotherapy. Self pay fees and some fee reductions based on financial hardship are possible.

With client consent, psychotherapists and other relevant professionals are kept informed of progress and are invited to collaborate with the client’s work in the group.

Michael Keller, MSW, LSCSW

Michael Keller is the former director of the Menninger Clinic DBT Program.

Michael Keller practices at (BMSPA) Behavioral Medicine Specialists, P.A.
BMSPA is a multi-disciplinary mental health counseling clinic serving children, adults, adolescents, couples and families.

For more information about the DBT group or other BMSPA services please contact us at 316-686-5195.