Social Anxiety–chapter number TBD

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Tanya Ruckstuhl-Valenti LICSW, MSW

(for those of you just now tuning in I am working on a book on social anxiety disorder and conveniently exploiting this blog for the purpose of motivating me to get the dang thing written.  This chapter will be early on in the book.  Your feedback is welcome and cherished even!).

Dynamic You!

In nature the only constant is change.  There is no standing still in the world, at least not for long.  Our bodies respond to gravity over time, our minds open up with experience and contemplation or shut tight, and when it comes to mental health in general and phobias in particular, we are either getting better or getting worse. 

Avoidant behavior, which means avoiding the thing you are afraid of, is the very thing your phobia tells you to do.  Unfortunately this strategy offers short term gain for long term pain:  it strengthens phobias.

One way to think about avoidance is that it’s like taking out a high interest payday loan to remedy running out of money: it’ll work for a short period of time but then it’ll make the original problem even worse.

A commonly occurring example of phobic avoidance can be seen among people who are afraid of flying and who, as a result, do not fly.  On the face of it, this seems like a reasonable behavior, especially if you are lucky enough to live close by to your extended family and not care for seeing the world.   Unfortunately not only does this avoidant behavior accidentally tell loved ones “you’re unimportant to me” it also makes you a perfect candidate for more phobias.

Why?  Avoidance is a recipe for greater fear, and un-confronted fear is a hydra-headed monster that morphs and multiplies, showing up in more and more areas of one’s life.

If you succeed in avoiding flying for several years you are guaranteed to be more afraid of flying the next time you try.  If you feed a phobia its food of choice, avoidance, you get more specific as well as more general phobias.

Cowboys have a succinct way of expressing this principle, “You got to get back on your horse.”  If they get bucked off, they know the faster they get back on, the quicker they will overcome the fear of being thrown out of the saddle again.

I once worked with a boy whose very loving mother had gone around to all of his teachers in high school and asked them not to call upon her son in class because he had an upsetting experience of stammering and being unable to continue reading aloud in a class during his freshman year.  He came into my office four years later, in a panic about the future.   About to move away to attend college, he was terrified of being made to speak in class.  Without his mother to buffer the professor’s expectations, he had to overcome his public speaking phobia in a hurry.  Luckily he was highly motivated, smart, had good family support and he was able to do it.  However I doubt they would have needed me in the first place if his mother had said to him four years earlier, “That sounds like a really tough experience,” and left it at that.

If you have social phobia, or any kind of phobia, repeated, dogged, and (temporarily) uncomfortable exposure is the most efficient, effective way to overcome it.  This book will serve as a recipe that you can follow until you are comfortable making progress on your own.

Exposure that Doesn’t Work…

Is abuse!   Imagine a three year old child crying out from fright after hearing the sudden, loud sound of a car backfire.   Would you slap the child in the face?   Of course not:  You would comfort them.    Yet, many people respond with agitation and negative self- judgment to their phobias.  Engaging in such metaphorical face-slapping self abuse in terms of abusive, judgmental self-talk, does not help the fear subside, in fact it strengthens the avoidance of the situation altogether, which strengthens the phobia.

If your internal self talk sounds like, “I can’t.  I should.  I’m such an idiot” you may want to consider taking a more effective approach.  Our frightened parts are young, and young frightened people need reassurance more than anything. 

Even Worse Than Avoidance…

Is addiction!  There are high co-morbidity (fancy therapist-speak for “at the same time”) rates of alcohol and drug addiction among the socially anxious because being mildly-to-strongly impaired temporarily stops the fear signals that the brain erroneously kicks out in social settings.  The operative word here is “temporary.”

The problem is that our bodies and brains have the capacity to adapt to just about anything, so that as tolerance for the alcohol or drug(s) occur, more and more must be used.  The more used, the greater the risk of negative side effects from the use itself such as addiction, accident, job loss, poverty, health problems and loss of motivation to heal the original problem of social phobia.  What started out as a crutch to lean on for support thus becomes a constant, increasing source of pain and additional shame which if left untreated can be fatal.

Addiction is a form of enslavement.  I hope you will join me in holding the belief that the human race has evolved beyond slavery.  Addiction is a baffling, destructive disease in which the addict plays both perpetrator as well as victim.

If you have turned to drugs or alcohol to blot out the pain of anxiety, you may be sliding into the grips of an addiction.  There are free, effective and community based support groups all over the world in the form of 12 step programs such as AA (Alcoholics Anonymous), and NA (Narcotics Anonymous).

If you have/had a loved one or parent who was or is addicted to alcohol, drugs or other compulsive behaviors, read Melanie Beattie’s book “Beyond Codependency” and go to an Al-Anon meeting.  Al-Anon is a support group for family and friends of addicts—not just for family members of alcoholics but for all people with loved ones who have any kind of addiction.

Other addictions among socially phobic fly lower on the radar because they are slower to cause death.  These include compulsive overeating (most commonly occurring in women) and compulsive sexual behavior (most commonly occurring in men) which includes compulsive viewing of pornography, use of prostitutes and unprotected one night stands.  There are twelve step groups for these folks as well.  OA, (Overeaters Anonymous) effectively treats compulsive overeaters as well as anorexics and bulimics.  SAA, (Sex Addicts Anonymous) effectively treats pornography addiction as well as other sexual risk taking behavior.   S-anon treats the partners of sex addicts in the same way that Al-Anon treats the partners of alcoholics and drug addicts.  You can locate any of these groups with the search engine of your choice.

In spite of a commonly held misconception, you do not need to believe in God or be Christian to join a twelve step program.   There are Buddhists, atheists and agnostics as well as Christians, Jews, Hindus, Shamans, Muslims and Pagans in the recovery movement.

Related articles

• What Is Social Phobia Natural Treatment (after50health.com)
• Symptoms Of A ‘Specific’ Phobia? (abcnews.go.com)

An Interview with Gloria Sandford

By Tanya Ruckstuhl-Valenti LICSW, MSW

Gloria Sandford MA, LMHC

This week I interviewed Gloria Sandford, a bright, intuitive and warm-hearted therapist specializing in addictions and co-dependency. 

If you are a therapist interested in learning more about community treatment of addictions within the scope of mental health, Gloria and I will be co facilitating “Becoming Twelve Step Savvy for Therapists” in the spring. 

If you are searching for a therapist who has addictions expertise, you can find Gloria on line at http://www.CreativeRecoverySolutions.com or email her at Gloria@CreativeRecoverySolutions.com or call her at 206 303-8506

What do you see as the intersections as well as the separations between addictions and mental health issues?

Addictions are a mental health issue.  Within addictions brain chemistry, thought patterns, behavioral patterns and family dynamics each play a role as in other mental health disorders.  Although overlap occurs, when viewed as a whole, addictions have a unique formation of symptoms requiring a unique response in treatment.

What do you wish the public knew about addictions?

Compassion 1^st, Boundaries 2^nd, Judgment Never.  Nothing happens in recovery work without compassion.  Boundaries come immediately after.  Addictions are a boundary-less disease/situation/form.  And without boundaries, treatment, friends and family will become overpowered and ineffective.

 

What boundaries do you recommend for family members of addicts?

Find out what really hits you as “not okay” and set boundary for yourself, for what will work for you.  Not what they need to do, but what you need to do.  Eventually, our boundaries will lead us to healthier boundaries, but at first we will cave, so it has to come from inside: where am I presently?  What needs to be okay to me? 

 

What advice would you give to someone who has a loved one that they suspect is addicted? 

Communicate!  Communicate your concerns with unemotional language and without judgment and you’ll have the best chance of being heard.

 

What would you say to someone who says, “I tried a 12 step meeting once and it was boring/stupid/etc…”?

That is normal.  It takes most people a number of tries to find a fit in 12-Step.  Why?  Because the big “D” of denial takes some time to conquer.

 

Anything else? 

Recovery takes time and there is no perfect way to achieve it.  There are no formulas only paths unique to each individual.  It is a journey toward health and one that I feel very privileged to walk along side.

 

 

 

 

 

 

Addictions and Mental Health

by Tanya Ruckstuhl-Valenti LICSW, MSW

I was talking with a friend recently who shared with me that she started going to AA after an incident of over-drinking in which she had to re-assess her own alcohol issues.  This is a particularly savvy and insightful person, and I was struck by her awareness of feeling irritable and resentful and her ability to connect this to sobriety. 

I started thinking about the how addictions offer a comfort—dysfunctional and emotionally expensive, but a comfort nonetheless—from feelings of malcontent and anxiety. 

When an addict stops their addiction there is no chemical or behavioral buffer between themselves and their emotions.  This is something the addict is rarely warned about in advance.  It will hurt.  Perhaps we don’t warn them because it’s hard enough to muster up the will to dump one’s best friend without knowledge of the loneliness that follows. 

Drug addicts report a six to twelve month depression following “kicking.”  As a sugar addict (I know that sounds wimpy by comparison, but believe me it’s the same thing) after I quit I went through months of self pity (“Other people do it!  Why can’t I?”—duh, cause I’m an addict!), of dreaming of chocolate and ice cream, of feeling at my wit’s end about how to celebrate, comfort or simply chill without desert products.   If I weren’t committed to self-awareness AND self acceptance it would be easy to look back and scoff at my naiveté and the extent to which food, rather than relationships, took center stage in my mind. 

I’m not sure we mental health providers offer full disclosure when we blithely recommend a separation from a substance or behavior of choice.  I think clients sense this loss and avoid complying with our recommendations because they are frightened, feeling that they alone know how important their addiction is to them.

This is why a twelve step program in addition to mental health services is recommended for successful treatment of addictions.  Therapy alone is famously unsuccessful at treating addictions (in AA’s Big Book, one of AA’s founders flies to Europe and receives treatment from the venerable Carl Jung…and is not helped). 

I would make the bold statement that 12 step groups alone are no more successful.  Many people in one twelve step group report that their addiction morphs into another one as soon as they feel comfortably abstinent. 

The focus of therapy is different from the focus of twelve step groups.  Your therapist is there to focus just on you.  Your twelve step group is there for you as well as themselves. 

Therapy provides a supportive and structured environment for exhuming old hurts, seeing how current behavior is influenced by previous trauma and answering the important WHY question: When it hurts, why do I act/think/feel this way?  The twelve step program provides a spiritual, social and emotional support system which answers the important HOW question: How do I live? 

Jettisoning an addiction hurts.  We are not meant to do life’s most difficult tasks alone.  And ultimately the effort; shared and mitigated by support and understanding, is worth it.  I liken it to getting cataract surgery for eye sight.  At first the light, shaded for so long by the damage of the cataract/addiction, hurts like hell….Then you can see clearly. 

 

 

Related Articles

• Twelve-step Approach to Recovery From Codependency (socyberty.com)
• Addiction during the holidays: Recovered or not, it’s important to be prepared (psychologytoday.com)
• Gender Differences in Trauma and Addictions (drsharma.ca)