Are your socially anxious teens surviving school?

Socially anxious adolescents struggle in the presence of others. Some don’t know what to say, some become self-conscious, and some feel as if they have nothing to contribute. Others feel judged and go out of their way to avoid being the center of attention. Simple things like accidently dropping a pencil, asking to use the bathroom, or getting up to throw something in the trash are treated as a crisis. Social anxiety can create problems in other areas of life, including the inability to simply feel at peace with oneself in large groups, classrooms, and school.

The dilemma: Avoidance of social situations can result in isolation, loneliness, despair, depression, increased stress, and suicide risk. Approaching social situations, especially without confidence, can be downright painful. Classes may be skipped and grades may drop.

Individual services for social anxiety is a challenge: The task is to make a connection without overwhelming the individual. Sometimes teens find “therapy” downright painful. Sometimes it “works” for a short period, but teens also need to find their way within their own peer groups.

Groups allow teens to participate passively, contribute without disclosure, and to experiment with finding their voice. It is not all about them all of the time. What a perfect venue for providing a service that is indirect yet direct! While individual services are helpful for solving emotional problems, group services replicate reality more realistically than 1:1 services with an adult. If teens are in places where peers offer spontaneous interactions while brainstorming solutions to conflict and emotional problems, the teen will be exposed to what life could be like if they open up. The increased comfort of speaking up and participating will translate into other peer settings- including school and eventually work.

Feeling comfortable speaking up and finding one’s voice is a powerful thing!

Does your teen have debilitating social anxiety? Please don’t hesitate to contact me…

Depressed? Anxious? Here’s What You Can Gain and Obtain

Most people who have more than their fair share of depression and anxiety are often seeking ways to decrease depressive and anxiety symptoms. In other words, they want to not be depressed and not have significant anxiety. If the symptoms are extreme or significant the person may start to avoid a lot of things, such as getting out of bed and going to places to that prompt panic attacks. Lifestyles can become restricted and the person may stop going to events or venues where they have the feelings they don’t want. Medications might be pursued, evaluated, and re-evaluated to see if they “work” or they “don’t work”.

If you are a depressed or anxious person, it might be worth considering what it is that you want more of, you would like to have, or what you value in your life. Instead of thinking what do I want to avoid start thinking about what you want to have more of in your life. What is it that would make your life more fulfilling, more engaging, more interesting, more desirable, or more alive? What is actually important to you? Sometimes people are so focused on what they are trying to get rid of they stop pursuing what they want.

Figuring out what you want more of ties in to your values, your energy, and your time. Are you sacrificing what is important to you because you are avoiding negative feelings? Have you stopped seeking activities that give you pleasure, fulfillment, obligation, a sense of contribution, or the opportunity to enhance an important relationship? If depression and anxiety interfere, this is a good time to evaluate what you might have to tolerate to go after more of what you want.

Sometimes, if people have more of what they want, their buffer against depression and anxiety can be tolerated more naturally. Some people get panic attacks at work, but because their job is important to them, they find a way to bear with them. Sometimes people get depressed when important things are lost, but because they have other important and meaningful activities in their life, the depression is bearable.

People who have fulfilled lives often have a wide range of things that give them pleasure, provide a sense of work/ mastery, invest in important relationships, and find new relationships when important ones end. Diversity and stability of the good things can help people shore up more resources when things go south and important jobs and relationships end.

 

 

 

 

Exposure treatment for panic: Do I really breathe through a straw?

Panic attacks? You may not think that putting someone into a panic is actually treatment for panic. However, the recommended treatment for panic consists of exactly that. It’s called exposure. Exposure works by purposely inducing the types of symptoms that arise when people get panicked. That’s not to say that an assessment wouldn’t include recent stressors, problem solving, or other interventions. It just means that when push comes to shove, what people are often scared of is having a panic attack in a situation where escape might be difficult.

When people panic, their sympathetic nervous system kicks into place. This increased arousal may be experienced as having sweaty palms, a racing heart, a feeling of lightheadedness, or shortness of breath. These types of symptoms can also be found in people that exercise hard.

The problem with panic is that people start to fear the symptoms of panic. They get panicked of having panic. And then the panic attack becomes more than it ever was. The original stressors that created the onset of panic almost disappear into the background.

Putting oneself in a situation -on purpose- where the above types of symptoms are experienced is a means for treating panic attacks. While it might be likely- or even ideal- to go through this with an experienced professional, the basic how-to’s for the treatment may include something like this:

  • Hyperventilating on purpose (take shallow breaths through the upper chest)
  • Breathing through a straw (pinch the straw if this is too easy)
  • Going round and round on a merry go round
  • Running up and down the stairs
  • Spinning around in circles

None of these exercises in and of themselves are harmful. It’s just that they can make you feel uncomfortable- and that’s often what people are afraid of! You could try anyone of them for 2-3 minutes.

The benefit of exposure is that your brain starts to get that you can tolerate physiological discomfort. When you tolerate physiological discomfort, the threat of uncomfortable sensation goes down. You could almost say- “This uncomfortable sensation is arising within me, and I can tolerate it. For the moment- I can be okay.” You may need to practice this multiple times before you start to get used to it- but you will need to weigh the costs/ benefits to letting your panic control your life.

Exposure is one approach to treating panic. Because once you get your brain back, you can use it to help you start problem solving other aspects of panic.

When not to use DBT skills: Conference highlights on treating anxiety disorders (with Melanie Harned, Ph.D. and Katheryn Korslund, Ph.D.).

This last week I was able to attend a wonderful conference on exposure-based treatments. Exposure therapy is basically this: If you are confronted with objects, sensations, or memories that you are afraid of over and over again eventually your fear of them goes down. Exposure is used to treat anxiety disorders such as panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. According to the conference presenters, 60-85% of anxiety-disordered clients who receive exposure therapy show clinically significant improvement.

One example of exposure treatment is for people who have panic attacks. Panic attacks generally include a range of symptoms such as a racing heart, shortness of breath, fear about going crazy or dying, numbness and tingling, feeling flushed, and intense physical sensations. In essence, when people have panic attacks they are often afraid of having more panic attacks. For instance, when a person runs a short distance, they may get out of breath (naturally!). Not so naturally, however, they may become flooded with anxiety that this is yet another panic attack coming on. Therefore they go out of their way to avoid anything that includes a racing heart, shortness of breath, or physical sensations associated with exercise. Perhaps this includes feeling their heart beat or feeling their breath. Therefore they may avoid any activity (or any emotion!) that involves physical sensations.

Exposure treatment for panic disorder involves facing and experiencing physical sensations. This is known as interoceptive exposure. For instance, clients are asked to participate in activities that create the feeling of not getting enough air in the lungs. Classic examples may include running up a staircase, breathing through one nostril through a straw, spinning around in a chair, or hyperventilating on purpose. (Hey, when I was in graduate school, we had to do all the above with our classmates!).

The important thing that makes exposure treatment work is that the person has to be alive, awake, attentive- and not under the influence of drugs, medications, or alcohol- to make it work. NO CHEATING!!! This is actually a time NOT to use DBT distracting skills. The point is that a person’s brain has to experience the situation differently when the person is exposed to the feared stimulus. Anxiety will go up- initially- and then it will go down. Otherwise the brain never learns! The new learning is experienced, and this makes all the difference in the world. No amount of rational cognitive problem solving is going to convince your brain otherwise.

This conference gave me new food for thought, allowed me to visit old material that I haven’t seen in a while, and was an excellent and thorough overview of exposure treatment for trauma (including when not to use it!). I will keep chewing on this food for thought- and definitely keep you posted.

Treatment for panic disorder

Panic disorder has a lot to do with being afraid of panicking. A comprehensive treatment will address fear of fear, which generally involves approaching verses avoiding fear. This is known as exposure. The basic concept of exposure is that a person stays in the presence of a threatening stimulus long enough for his or her fear to go down, at least a little bit.

When a person has a panic attack it is not uncommon for the person to fear the panic itself. This has the paradoxical effect of making the panic worse. For instance, it is normal for a person’s heart to race when exercising. A person who has panic attacks may start to become hypersensitive to feeling his or her heart racing.  This may result in the person’s avoidance of going up or down stairs. While the intention is to avoid panic, this can be problematic as more situations become associated with the panic. Eventually the panic is more in control of the person than the person is in control of the panic.

Most of the time, the situations, events, or circumstances the person is afraid of are not harmful. Treatment generally consists of educating people on panic and non-useful ways of thinking, It involves helping people regulate anxiety through breathing exercises, controlling their body with progressive muscle relaxation, and facing feared situations over and over again until the fear goes down. Part of emotion regulation training encourages persons to identify the function of the fear (Does it truly help them avoid harmful situations? Or is the fear getting them to avoid living the life they want?). Too much fear may be fear worth trying to change. The DBT opposite-action-to-emotion skill is to approach, which is exactly on target with evidence-based treatments for treating fears and phobias.