1. Will medication "cure" me so that I no longer have social anxiety?

No. Medication can be helpful, when combined with cognitive-behavioral therapy, but it is not able to produce permanent changes in your brain. By actually learning new ways to think and by slowly (and in a non-pressuring way) acting on these thoughts, your brain pathways actually change physiologically, and this brings about a gradual, permanent change in your feelings.

2. I’ve heard that cognitive-behavioral therapy is stressful. Is this true?

Although cognitive-behavioral therapy is an active, focused treatment, it can never be deliberately stressful or pressuring in nature or it will not work with socially-anxious people. Instead, cognitive-behavioral treatment is gentle, challenging, and works by "hierarchy" (moving up one step at a time).

3. I was told I should "force" myself into difficult anxiety-producing situations and I would get over my social anxiety.

The advice to "flood" yourself with high anxiety so that you will get better does NOT work for people with social anxiety. The attempt to perform an activity that is highly anxiety-arousing almost guarantees failure for the person. This, in turn, leads to further embarrassment, humiliation, and depression.

4.   If forcing myself into social situations doesn't work, how will I ever get better?

It is important to start more slowly and gradually work up gently to the place you'd like to be. We always use cognitive (re-thinking) methods and strategies first to provide the person with a foundation of new thinking skills and anti-anxiety strategies that are beginning to "sink down" deeply into the brain so that they become a habit or an automatic behavior. We feel therapy is much more successful if these cognitive strategies are learned and deeply dropped into the brain first. Then, when a person feels less social anxiety and a little more confident, they decide to move into the social anxiety therapy group where changes in behaviors are worked on more directly. However, we make it a rule that no one is ever forced, challenged, or urged to do anything they don't feel like doing in the group. The motivation and impetus must come directly from the person with social anxiety. We have found this approach to group therapy to be most effective.

5.  I think I would just sit there in group and be scared to death. How many people get up enough nerve to actually do something during the group therapy meetings?

We wouldn't admit you into the group until you felt a little more confident about your abilities. That is the purpose of the cognitive therapy emphasis during individual sessions. Of course, everyone is anxious during the first group therapy sessions, but the promise that no one will be singled out, asked to say anything, or put on display makes everyone feel more comfortable. Also, we never do the "introduction" game of going around the circle and introducing ourselves at the first meeting (socially-anxious people will fully understand this one!) The rule is that no one ever has to do anything they don't want to do.

As a result, we've never run a therapy group where an individual hasn't wanted to work on their anxiety in social situations. We follow a specific, but fluid, hierarchy or "ladder" of anxiety-causing behaviors for each individual, but it is always the person with social anxiety that has full control over what is actually done.

6. I have a psychiatrist and a psychologist, but I felt like I knew more than both of them by researching Social Phobia on the net and reading Dying of Embarrassment.

I know I can conquer this fear, and I also know that I am going to need some good coaching from someone who knows what they are talking about. Thank you for your time and suggestions.

You are correct -- your assessment is right on target. At present, we don't know of any social anxiety therapists in your area, but I will attach a text message showing you how to access the Anxiety Disorders Association of America therapy pages. The only problem with this strategy is that anyone who pays dues can join. Therefore, before you make any appointments, call and check the therapist out first and make sure they understand what social phobia is. Because if they don't know what it is, how will they know how to coach you out of it? Yes, I think several of our articles on The Anxiety Network -- Social Phobia/Social Anxiety Home Page -- address this issue of finding the right therapist. Take care. Let me know what you find out and how you're doing.

7.   First off let me say thanks for the quick reply! I really appreciate your advice, and that you take the time to help a total stranger, and yes, I'm one of those that decided a long time ago, "I'll just live with it." I'll tell you a little about my anxiety problems and will try not to be too boring. When it started, I was out with my friend smoking pot, which I had done quite often in the past. This particular time I was higher than I'd ever been. This was during school lunch hour. I got back to school and was too paranoid to go back to class so I went to the bathroom and started eating my lunch I'd brought. Suddenly, I felt my heart racing...this was the main symptom I recall back then, and as you'd expect, I thought I was dying...a heart attack? I wasn't sure, but I knew something was wrong. I ran and got help and was taken to a hospital.

They checked me out and said I was fine....nothing wrong with me. Well, it went away and I didn't think much more about it. A couple of days went by, and I got high again. Sure enough, I had another anxiety attack. This time I just had a feeling of.....well, I guess it was sort of like unreality......and a general fear that I was dying. I went home immediately and told my parents I was going to die and they sat with me. I guess the anxiety fed on itself because I became worse and started to hyperventilate. Another trip to the hospital and I got the same result. "There's nothing wrong with you". So what you said made sense -- hearing that nothing was wrong with me made it worse.

I thought, "Yes, there is, but you don't know what it is! I must have something wrong with my mind that nobody else has." I was having a severe panic attack, but the bad part was it wasn't like a normal one. I got home from the hospital and it didn't get better. The attack stayed the same strength. It was like a permanent panic attack.

Somehow my mother was told that I might have an anxiety disorder. She talked to a doctor at a mental hospital and they told her I should be taken to them. I told my mother I was going to kill
myself because I couldn't take this, so that was all she needed to hear and she took me to the mental hospital.

At the mental hospital they told me I had anxiety attacks, and that was about it. My doctor even said he didn't know anything about how to help with it besides giving me medicine. I tried taking the medicine he gave me and it made the anxiety worse somehow. After 3 days I still had VERY strong anxiety. Not all the symptoms but I would say the majority of them. Still, though, it was nonstop. It didn't peak and then get better.....then attack again.....it was like I said: permanent. I couldn't stop moving. I felt my heart beating in my ears and chest. I had terrible chest discomfort and muscle tension. There was bizarre feelings I can't describe....unreality maybe.....thought I was going crazy.....after a week maybe. it finally got a
little better. but I associated this anxiety with drugs (pot) so in the end it turned out to be ANY
drugs.. .including aspirin and antibiotics.....that would give me a panic attack. I had anticipatory anxiety just from thinking about taking them.

What helped me, I think, was the fact that I became more and more suicidal. I started not caring if this killed me. In fact, I hoped it would. I quit worrying if my heart beating fast would kill me so it didn't beat like that anymore. I didn't care if I suffocated so I breathed pretty normal.

Years later, I was forced to take certain medicine because of REAL medical problems and they didn't bother me like I feared they would. I even drink on occasion now. Every once in awhile I'll wake up in the morning after drinking and will have an anxiety attack that lasts about 1 or 2 days, but it's mild. The muscle tension being the main thing that
bothers me. That's my worst symptom now. I haven't smoked pot and the serious contemplation it gives me anxious thoughts.....so I have stayed away from it. I don't take medicine usually unless I REALLY need it, but my panic in general is very mild compared to what it once was. It's either gotten better...or just evolved in some way to something different.

This was long I know.....sorry. but it's still just a basic and rushed explanation of how it has been.

As to the social phobia.....this will be quicker. My whole life I have been very shy.  That is, until I became fairly close friends with someone -- then I can become a leader. I can be outgoing as anyone. A few years after I started having panic attacks this "shyness" became worse. The job I have now is a good example of how I am today. My mother became very very mad at me because I sat around the house doing nothing useful. No job...no school...just doing nothing. She told me to get off my butt and get a job.

I WANTED one...I needed money.....but I was deathly afraid to even try. No references...and I felt very uncomfortable at the thought of going in for an interview. I didn't understand this. Why was I so afraid? I thought maybe I was lazy. I finally forced myself to apply to a few jobs and amazingly, I thought, one had me come in for an interview. The interview went as you would expect (me jumbling words and trying to blow it), but they hired me anyway. I think it was about a whole month before I actually had a real conversation with any of my co-workers. I'm pretty comfortable there now, but still if there is any staff meetings or training classes, it's just like the stories on your page. Feelings that people are watching or criticizing....picking on me and secretly laughing inside. That's work though.

I have no social life anymore. I don't like people, is what I say. I get on the internet, or read books, play my Sony playstation.....and I feel completely comfortable. Now anytime I go out in the public.....deal with anyone.....or just walk down the street I feel so uncomfortable I just want to get out of there as fast as I can. When I first meet a stranger I say maybe, "how are you doing?" and "my name's Jason". That's about it. That never happens though now....I don't associate with ANYONE now. My home is my haven.

To summarize: my panic attacks are very mild now, so I don't think about it as much. This social phobia on the other hand....you know how you think, 'nobody could ever feel like I'm feeling now'? Your page is why I said I was shocked! I related so well with it that I'm now POSITIVE I have it. Every way you described it sounded like myself. While I think I still have panic, I'm not sure if it's possibly related to this social phobia. Maybe I have both or it's just the one? What do you think? And thanks again...you made me also realize that this depression I have is most likely caused by one or both of these things we are talking about. By the way, I read everything on your page. All the links.

I made an appointment with a mental health care facility for this coming Monday.  They told me they have people that are trained to deal with social phobias. They didn't say if those trained were specialized in it, but I'll find out Monday. If you could tell me some good questions to ask to find out if they are the councilors I need, it would be a great help. Once again I thank you for your time and help and hope this HUGE boring letter does not disgust too much.

Answer:  First of all, your e-mail was not boring or disgusting at all. It was both interesting and helpful. Because I had social anxiety for 20 years myself, I can feel everything you're feeling and I know it isn't fun. You're not crazy; there's nothing wrong with you except for the current social anxiety and the depression that always goes along with it. I wish you lived closer because it is my joy in life to work with social phobia people and see them overcome this disorder and walk into new lives. That is why I get up every morning.

Yes, it does sound as if you had classic symptoms of panic disorder when you were a teenager. And it does sound like panic has bled over into social anxiety more strongly now. That is what I meant on the pages: One or the other anxiety disorder is usually dominant, at any one given time. Today, however, from what you write, it sounds like the social anxiety symptoms are more prevalent.

I'm glad that you're seeking help; the only problem, as I've mentioned is that social anxiety (although it affects 8% of the American population) is never heard about -- and psychologists/therapists are not trained in graduate school as to its definition, let alone as how to overcome it through cognitive-behavioral therapy.

8.  Ask questions of your therapist such as:

"How much of your practice is geared toward people with social phobia?" (They can't simply answer "yes" or "no" to this question.)

"I was told all my life that most of my problem was panic. Now someone has told me it may be social anxiety. Can you tell me what the symptoms of social anxiety are?" Make THEM tell YOU what the symptoms are so that you can check to see if they truly understand the disorder.

Then, because research has been clear that cognitive-behavioral therapy is the only effective therapy for overcoming social anxiety, ask what changing your "cognitions" (thoughts) means -- and HOW ARE THEY GOING TO DO THAT? If they say you two are going to "talk" about it, stop! Remember talking about your anxiety over and over again just depresses us more -- and then we never make any progress.

Your therapist should have specific methods, techniques, and strategies all written down (printed) on handouts that explains what to practice and WHY (the rationale behind it or how it will make you better over time). For example, we have over 200 handouts here that we use with our social anxiety people -- every week we move forward, learn new methods of dealing with social anxiety, and eventually put them into practice so that they are permanent changes the brain makes.

They should also have a behavioral therapy group for people with social anxiety. After individual CBT (when you're feeling stronger and better about yourself, you begin a group of 5-10 people who are also people with social anxiety and you work on the things (such as making introductions around the room, speaking in a small group, etc.) very slowly and gradually so that your successes build up.

Group therapy nights are always my favorite nights of the week, because even though I know my people are a little anxious, they will be making more progress and moving closer to their goal. Everyone here who has gone through the behavioral group(s) has moved up and forward -- either into college or a return to college, into a job, into a new job, or they've been able to accept a promotion to the level they are more capable of -- because now they know how to handle the anxiety.

I know. It happened to me and I've seen it happen now to dozens and dozens of others. Sometimes the going is rough, but if you find the right therapist and stick with it, you WILL get better and then gradually overcome the whole thing. It is very positive. The only hindrance to all this is -- we need more therapists who know what to do.

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

"Overcoming Social Anxiety": The 20 session audio therapy series

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